Combination therapy of acellular pro-tolerogenic and pro-inflammatory preparations for modulating the immune system

ABSTRACT

This disclosure relates to a cellular-based therapies for modulating the level of regulatory T cells (Treg) and/or the level of pro-inflammatory T cells (Th17/Th1). To provide these therapeutic effects, a combination comprising at least one a cellular pro-tolerogenic preparation and at least one a cellular pro-inflammatory preparation are administered sequentially.

CROSS-REFERENCE TO RELATED APPLICATIONS

This application is a national phase application under 35 U.S.C. § 371 of International Application No. PCT/CA2015/050647 filed 10 Jul. 2015, which claims priority to U.S. Provisional Application No. 62/023,072 filed 10 Jul. 2014. The entire contents of each of the above-referenced disclosures is specifically incorporated by reference herein without disclaimer.

TECHNOLOGICAL FIELD

The present disclosure relates to the use of a combination of acellular-based preparations (obtained from contacting allogeneic leukocytes) to modulate the ratio in the level of regulatory T (Treg) cells to the level of pro-inflammatory T cells. The combination can be used to temporarily modulate the Treg cells/pro-inflammatory T cells ratio or adjust the ratio in view of the progression of the condition that is being prevented, treated and/or alleviated.

BACKGROUND

The immune response evolved to be inherently adaptable depending on the challenges it meets. In some instances, pregnancy for example, the immune response is reduced and tolerates immunological triggers or insults. In other instances, a microbial infection for example, the immune response is strong and allows the return to an homeostatic state.

However, in some individuals the immune balance is pathologically tipped either towards inflammation (e.g., a pro-inflammatory state, as observed in autoimmune diseases for example) or anergy (e.g., a pro-tolerogenic state, as observed in proliferation associated disorders for example) which leads to the onset of various conditions which may be long-lived and detrimental to the afflicted individuals. In order to mitigate such conditions, various therapeutics have been designed to restore an immune balance which will limit or prevent the pathological consequences associated with the onset of such conditions.

Therapeutics that are capable of restoring the immune balance, and more specifically capable of modulating the ratio of T regulatory (Treg) cells to pro-inflammatory T cells, have been described. A first class of biological therapeutics has been designed to decrease the ratio of Treg/pro-inflammatory cells in order to intentionally induce a more inflammatory immune state in individuals having a low or inappropriate immune response (refer to, for example, PCT patent applications PCT/CA2013/050546 (published under WO2014/008611) and PCT/CA2013/050963). These biological therapeutics are especially useful in mediating therapeutic benefits in individuals afflicted by a proliferation-associated disorder such as cancer. Other biological therapeutics have been designed to increase the ratio of Treg/pro-inflammatory T cells to intentionally induce a more tolerogenic immune state in individuals having an exacerbated immune response (refer to, for example, U.S. patent application Ser. No. 13/941,303 (published under US 2014/0017218), PCT patent applications PCT/CA2013/050547 (published under WO2014/008612), PCT/CA2013/050543 (published under WO2014/008608), PCT/CA2013/050544 (published under WO2014/008609) and PCT/CA2013/050545 (published under WO2014/008610)). This second class of biological therapeutics can provide therapeutic benefits in individuals afflicted by an auto-immune disease or at risk of rejecting a graft.

Even though some of the biological therapeutics have been show to induce long-lived beneficial immune modulating effects in individuals having received them, there exists a need for further modulating the immune response in some situations. For example, while providing therapeutic benefits to individuals afflicted by an auto-immune disease (by intentionally inducing a pro-tolerogenic immune state), these biological therapeutics also impede the immune response of the treated individuals towards a vaccine. As such, it may be beneficial for individuals having received biological therapeutics intentionally inducing a pro-tolerogenic state to have the ability, at least temporarily, to mount a robust immune response against an immunogen, such as the components of a vaccine. In another example, individuals having received a biological therapeutic intentionally inducing a pro-inflammatory state to favor tumor resorption could also benefit from a more pro-tolerogenic state prior to a tissue or a cell graft. As such, it may be beneficial for individuals having received biological therapeutics intentionally inducing a pro-inflammatory state to have the ability, at least temporarily, to avoid mounting an immune response against a grafted tissue or a transplanted cell.

It would be highly desirable to be provided with therapeutic combinations capable of modulating the immune response in an individual to provide immune stimulation when a pro-tolerogenic immune state was intentionally induced or immune tolerance when a pro-inflammatory immune state was intentionally induced. In some embodiments, it would also be highly desirable for some individuals to revert back to the intentionally induced pro-tolerogenic immune state or the intentionally induced pro-inflammatory immune state.

BRIEF SUMMARY

One aim of the present disclosure is to provide a therapeutic combination of acellular-based preparations capable of inducing, in a sequential manner, a state of immune stimulation and a state of immune tolerance. The acellular-based preparations and therapies presented herewith are derived from the contact of at least two distinct leukocyte populations which are considered allogeneic with respect to one another. The two leukocyte populations are contacted under conditions so as to allow either a pro-inflammatory allo-recognition and ultimately induce immune stimulation or a pro-tolergenic allo-recognition to ultimately induce immune tolerance. The two leukocyte populations can be contacted in vitro, ex vivo or in vivo to induce immune stimulation and/or a pro-inflammatory state. The acellular-based preparations are obtained in a process which limits or inhibits the degradation of nucleic acids, such as miRNAs and can even include an mi-RNA enrichment step.

According to a first aspect, the present disclosure relates to a therapeutic combination comprising at least one acellular pro-tolerogenic preparation and at least one acellular pro-inflammatory preparation. In such combination, the at least one acellular pro-tolerogenic preparation and the at least one acellular pro-inflammatory preparation are adapted for a sequential administration to a subject. The at least one acellular pro-tolerogenic preparation is obtained by a first process comprising: (i) associating a low-immunogenic biocompatible polymer to a cytoplasmic membrane of a first leukocyte to obtain a first modified leukocyte; (ii) contacting the first modified leukocyte with a second leukocyte under conditions to allow a pro-tolerogenic allo-recognition to provide a pro-tolerogenic conditioned preparation, wherein the first modified leukocyte is allogeneic to the second leukocyte; (iii) removing the first modified leukocyte and the second leukocyte from the pro-tolerogenic conditioned preparation under conditions to inhibit RNA degradation so as to obtain a pro-tolerogenic composition enriched in acellular pro-tolerogenic components; and (iv) formulating the pro-tolerogenic composition of step (iii), under conditions to inhibit RNA degradation, in the acellular pro-tolerogenic preparation for administration to the subject. The at least one pro-inflammatory preparation is obtained by a second process comprising: (a) contacting a third leukocyte with a fourth leukocyte under conditions to allow a pro-inflammatory allo-recognition to provide a pro-inflammatory conditioned preparation, wherein the third leukocyte is allogeneic to the fourth leukocyte; (b) removing the third leukocyte and the fourth leukocyte from the pro-inflammatory conditioned preparation under conditions to inhibit RNA degradation so as to obtain a pro-inflammatory composition enriched in acellular pro-inflammatory components; and (c) formulating the pro-inflammatory composition of step (b), under conditions to inhibit RNA degradation, in the acellular pro-inflammatory preparation for administration to the subject. In an embodiment, the acellular pro-tolerogenic preparation is adapted to be administered to the subject prior to the acellular pro-inflammatory preparation. In still another embodiment, the therapeutic combination further comprises at least two acellular pro-tolerogenic preparations, wherein the first acellular pro-tolerogenic preparation is adapted to be administered to the subject prior to the acellular pro-inflammatory preparation and wherein the second acellular pro-tolerogenic preparation is adapted to be administered to the subject after the acellular pro-inflammatory preparation. In yet another embodiment, the acellular pro-tolerogenic preparation is adapted to be administered to the subject after the acellular pro-inflammatory preparation. In another embodiment, the therapeutic combination further comprises at least two acellular pro-inflammatory preparations, wherein the first acellular pro-inflammatory preparation is adapted to be administered to the subject prior to the acellular pro-tolerogenic preparation and wherein the second acellular pro-inflammatory preparation is adapted to be administered to the subject after the acellular pro-tolerogenic preparation.

In still another embodiment, the first process, at step (i), further comprises covalently binding the low-immunogenic biocompatible polymer to a membrane-associated protein of the cytoplasmic membrane of the first leukocyte. In still a further embodiment, the low-immunogenic biocompatible polymer is a polyethylene glycol (PEG), such as, for example a methoxy polyethylene glycol (mPEG). In a further embodiment, the first process further comprises covalently binding the mPEG by contacting the first leukocyte with methoxypoly(-ethylene glycol) succinimidyl valerate. In yet another embodiment, step (ii) of the first process occurs in vitro. In such embodiment, the first process, at step (ii), can further comprise culturing the first modified leukocyte and the second leukocyte. In an embodiment, the pro-tolerogenic conditioned preparation is a supernatant of the cell culture. In another embodiment, the first process, prior to step (ii), further comprises preventing one of the first modified leukocyte or the second leukocyte from proliferating. In still a further embodiment, step (ii) of the first process occurs in vivo. In such embodiment, the first process, at step (ii), can further comprise administering the first modified leukocyte to a mammal having the second leukocyte. In yet another embodiment, the pro-tolerogenic conditioned preparation is a plasma of the mammal. In another embodiment, the first process, prior to step (ii), further comprises preventing the first modified leukocyte from proliferating prior to administration to the mammal. In yet a further embodiment, the first process, at step (iii), further comprises removing components having an average molecular weight of more than about 10 kDa from the pro-tolerogenic conditioned preparation, for example, the first process, at step (iii), can further comprise filtering out components having the average molecular weight of more than about 10 kDa from the pro-tolerogenic conditioned preparation. In still another embodiment, the first process, at step (iii), further comprises enriching the pro-tolerogenic conditioned preparation in at least one miRNA species. In another embodiment, the first process, at step (iv), further comprises formulating the acellular pro-tolerogenic composition for intravenous administration to the subject.

In yet another embodiment, step (a) of the second process occurs in vitro. In such embodiment, the second process, at step (a), can further comprise culturing the third leukocyte and the fourth leukocyte. In an embodiment, the pro-inflammatory conditioned preparation is a supernatant of the cell culture. In still a further embodiment, the second process, prior to step (a), further comprises preventing one of the third leukocyte or the fourth leukocyte from proliferating. In another embodiment, step (a) of the second process occurs in vivo. In such embodiment, the second process can further comprise administering the third leukocyte to a mammal having the fourth leukocyte. In an embodiment, the pro-inflammatory conditioned preparation is a plasma from the mammal. In still another embodiment, the second process, prior to step (a), further comprises preventing the third leukocyte from proliferating prior to administration to the mammal. In yet another embodiment, the second process, at step (b), further comprises removing components having an average molecular weight of more than about 10 kDa from the pro-inflammatory conditioned preparation, for example, the second process, at step (b), can further comprise filtering out components having the average molecular weight of more than about 10 kDa from the pro-inflammatory conditioned preparation. In an embodiment, the second process, at step (b), further comprises enriching the pro-inflammatory conditioned preparation in at least one miRNA species. In yet another embodiment, the second process, at step (c), further comprises formulating the acellular pro-inflammatory composition for intravenous administration to the subject.

In still another embodiment, at least one of the first leukocyte, the second leukocyte, the third leukocyte or the fourth leukocyte is a T cell (a CD4-positive T cell or a CD8-positive T cell). In yet another embodiment, at least one of the first leukocyte, the second leukocyte, the third leukocyte and the fourth leukocyte is a peripheral blood mononucleated cell. In a further embodiment, at least one of the first leukocyte, the second leukocyte, the third leukocyte and the fourth leukocyte is a splenocyte.

In another embodiment, the acellular pro-tolerogenic preparation has at least one miRNA species presented in FIG. 9, listed in any one of Tables 1A to 1D, listed in any one of Tables 2A to 2D or presented in any one of FIGS. 8A to 8C. In a further embodiment, the acellular pro-inflammatory preparation has at least one miRNA species presented in FIG. 9, listed in any one of Tables 1A to 1D, listed in any one of Tables 2A to 2D or presented in any one of FIGS. 8A to 8C.

In a second aspect, the present disclosure provides a therapeutic kit comprising at least one acellular pro-tolerogenic preparation as defined herein, at least one acellular pro-inflammatory preparation as defined herein and instructions for using the at least one acellular pro-tolerogenic preparation and the acellular pro-inflammatory preparation in a sequential manner. In an embodiment, the instructions specify that the acellular pro-tolerogenic preparation for administration to the subject prior to the acellular pro-inflammatory preparation. In still another embodiment, the therapeutic kit further comprises at least two acellular pro-tolerogenic preparations, wherein the instructions specify that the first acellular pro-tolerogenic preparation is for administration to the subject prior to the acellular pro-inflammatory preparation and the second acellular pro-tolerogenic preparation is for administration to the subject after the acellular pro-inflammatory preparation. In still another embodiment, the instructions specify that the acellular pro-tolerogenic preparation is for administration to the subject after the acellular pro-inflammatory preparation. In yet another embodiment, the therapeutic kit further comprises at least two acellular pro-inflammatory preparations, wherein the instructions specify that the first acellular pro-inflammatory preparation is for administration to the subject prior to the acellular pro-tolerogenic preparation and the second acellular pro-inflammatory preparation is for administration to the subject after the acellular pro-tolerogenic preparation.

In a third aspect, the present disclosure provides a method of modulating a ratio of the level of regulatory T (Treg) cells to the level of pro-inflammatory T cells in a subject in need thereof, said method comprising administering a therapeutic amount of at least one acellular pro-inflammatory preparation as defined herein to the subject having received a therapeutic amount of at least one acellular pro-tolerogenic preparation as defined herein. In an embodiment, the method further comprises identifying that the subject is need of a decrease of the ratio of the level of Treg cells to the level of pro-inflammatory T cells prior to the administration of the at least one acellular pro-inflammatory preparation. In another embodiment, the method further comprises administering to the subject a therapeutic amount of the at least one acellular pro-tolerogenic preparation prior to the administration of the therapeutic amount of the at least one acellular pro-inflammatory preparation. In still another embodiment, the method further comprises identifying that the subject is need of an increase of the ratio of the level of Treg cells to the level of pro-inflammatory T cells prior to the administration of the at least one acellular pro-tolerogenic preparation. In an embodiment, the need for the decrease of the ratio is for treating, preventing and/or alleviating the symptoms associated with a condition caused or exacerbated by a reduced immune response in the subject. In still another embodiment, the condition is a proliferation-associated disorder. In yet another embodiment, the proliferation-associated disorder is cancer. In a further embodiment, the condition is an infection (for example, a parasitic infection, a viral infection, a bacterial infection and/or a fungal infection). In still another embodiment, the condition is an immune response to a vaccine. In a further embodiment, the need for the increase of the ratio is for treating, preventing and/or alleviating the symptoms associated to an auto-immune disease afflicting the subject (such as, for example, type I diabetes, rheumatoid arthritis, multiple sclerosis, psoriasis, lupus, immune thrombocytopenia, experimental autoimmune encephalomyelitis, autoimmune uveitis, inflammatory bowel disease, scleroderma and/or Crohn's disease). In yet another embodiment, the need for the increase of the ratio is for preventing or limiting the rejection of transplanted cells or tissue in the subject. In still a further embodiment, the transplanted cells or tissue are allogeneic or xenogeneic to the subject.

In a fourth aspect, the present disclosure provides a method of modulating a ratio of the level of regulatory T (Treg) cells to the level of pro-inflammatory T cells in a subject in need thereof, said method comprising administering a therapeutic amount of at least one acellular pro-tolerogenic preparation as defined herein to the subject having received a therapeutic amount of at least one acellular pro-inflammatory preparation as defined herein. In an embodiment, the method further comprises identifying that the subject is need of an increase of the ratio of the level of Treg cells to the level of pro-inflammatory T cells prior to the administration of the at least one acellular pro-tolerogenic preparation. In still another embodiment, the method further comprises administering to the subject a therapeutic amount of the at least one acellular pro-inflammatory preparation prior to the administration of the therapeutic amount of the at least one acellular pro-tolerogenic preparation. In yet another embodiment, the method further comprises identifying that the subject is need of a decrease of the ratio of the level of Treg cells to the level of pro-inflammatory T cells prior to the administration of the at least one acellular pro-inflammatory preparation. In an embodiment, the need for the decrease of the ratio is for treating, preventing and/or alleviating the symptoms associated with a condition caused or exacerbated by a reduced immune response in the subject. In still another embodiment, the condition is a proliferation-associated disorder. In yet another embodiment, the proliferation-associated disorder is cancer. In a further embodiment, the condition is an infection (for example, a parasitic infection, a viral infection, a bacterial infection and/or a fungal infection). In still another embodiment, the condition is an immune response to a vaccine. In a further embodiment, the need for the increase of the ratio is for treating, preventing and/or alleviating the symptoms associated to an auto-immune disease afflicting the subject (such as, for example, type I diabetes, rheumatoid arthritis, multiple sclerosis, psoriasis, lupus, immune thrombocytopenia, experimental autoimmune encephalomyelitis, autoimmune uveitis, inflammatory bowel disease, scleroderma and/or Crohn's disease). In yet another embodiment, the need for the increase of the ratio is for preventing or limiting the rejection of transplanted cells or tissue in the subject. In still a further embodiment, the transplanted cells or tissue are allogeneic or xenogeneic to the subject.

Throughout this text, various terms are used according to their plain definition in the art. However, for purposes of clarity, some specific terms are defined below.

Allogeneic cell. A cell is considered “allogeneic” with respect to another cell if both cells are derived from the same animal species but presents sequence variation in at least one genetic locus. A cell is considered “allogeneic” with respect to a subject if the cell is derived from the same animal species as the subject but presents sequence variation in at least one genetic locus when compared to the subject's respective genetic locus. Allogeneic cells induce an immune reaction (such as a cell-based immune reaction, a rejection for example) when they are introduced into an immunocompetent host. In an embodiment, a first cell is considered allogeneic with respect to a second cell if the first cell is HLA-disparate (or HLA-mismatched) with respect to the second cell.

Allo-recognition. As it is known in the art, the term “allo-recognition” (also spelled allorecognition) refers to an immune response to foreign antigens (also referred to as alloantigens) from members of the same species and is caused by the difference between products of highly polymorphic genes. Among the most highly polymorphic genes are those encoding the MHC complex which are most highly expressed on leukocytes though other polymorphic proteins may similarly result in immune recognition. These polymorphic products are typically recognized by T cells and other mononuclear leukocytes. In the context of the present disclosure, the term “pro-inflammatory allo-recognition” refers to an immune response associated with the expansion of pro-inflammatory T cells and/or the differentiation of naïve T cells into pro-inflammatory T cells. Pro-inflammatory allo-recognition in vivo mediates cell or tissue injury and/or death and loss of cell or tissue function. Still in the context of the present disclosure, the term “pro-tolerogenic allo-recognition” refers to an immune response associated with the expansion of Treg cells and/or the differentiation of naïve T cells into Treg cells and/or a decrease in the expansion of pro-inflammatory T cells (e.g., Th1, Th17 cells) and/or differentiation of naïve T cells to pro-inflammatory T cells. A pro-tolerogenic allo-recognition is usually considered weaker than a pro-inflammatory allo-recognition. Further, an in vivo pro-tolerogenic allo-recognition does not lead to significant cell or tissue injury and/or death nor to loss of cell or tissue function.

Anergy and Tolerance. In the present context, the term “anergy” refers to a non-specific state of immune unresponsiveness to an antigen to which the host was previously sensitized to or unsensitized to. It can be characterized by a decrease or even an absence of lymphokine secretion by viable T cells when the T cell receptor is engaged by an antigen. In the present context, the term “tolerance” (also referred to as a pro-tolerogenic state) refers to an acquired specific failure of the immunological mechanism to respond to a given antigen, induced by exposure to the antigen (e.g., a tumor antigen for example). Tolerance refers to a specific nonreactivity of the immune system to a particular antigen, which is capable, under other conditions, of inducing an immune response. However, in the present context, the terms “anergy” and “tolerance” are used interchangeably since the compositions and methods presented herewith can be used to achieve both anergy and tolerance.

Autologous cell. A cell is considered “autologous” with respect to another cell if both cells are derived from the same individual or from genetically identical twins. A cell is considered “autologous” to a subject, if the cell is derived from the subject or a genetically identical twin. Autologous cells do not induce an immune reaction (such as a rejection) when they are introduced into an immunocompetent host.

Conditions associated with a reduced (low or inappropriate) immune response. In the context of the present disclosure, the subjects afflicted by these conditions have increased ratio of Treg to pro-inflammatory T cells when compare to the same ratio of sex- and age-matched healthy subjects. Alternatively, the subjects afflicted by these conditions may have normal ratios of Treg to pro-inflammatory T cells but exhibit a reduced to absent proinflammatory response to antigenic stimuli. In some embodiments, the immune system of subjects afflicted by a condition associated with a low, repressed or inappropriate immune response is in a state of anergy. The immune system of some of the subjects afflicted by these conditions fails to produce target specific pro-inflammatory cell (T and B lymphocytes) capable of recognizing and destroying abnormal cells (e.g., cancer cells or infected cells). Alternatively, the immune system of some of the subjects afflicted by these conditions exhibit elevated levels of regulatory T and B cells that inhibit normal pro-inflammatory T and B cells from exerting their function (i.e. inducing a partial or complete immune suppression) thereby preventing destruction of an abnormal cell of cell aggregates. One of these conditions is a proliferation-associated disorder (such as, for example, cancer). Another of these conditions is an infection (such as for example a parasitic infection).

Immune stimulation. In the present context, the term “immune stimulation” or “pro-inflammatory state” refers to a state of immune responsiveness to an antigen and such response is independent of the host's previous sensitization to the antigen. It can be characterized by an increase or a modulation in the level of lymphokine secretion by viable T cells when the T cell receptor is engaged by an antigen. In the present context, the term “stimulation” refers to an acquired specific activation of the immunological mechanism to respond to a given antigen, induced by exposure to the antigen. In the context of the present disclosure, the immune stimulation is considered therapeutic and specifically excludes inflammatory diseases, conditions and/or disorders.

Immunogenic cell. A first cell is considered immunogenic with respect to a second cell when it is able to induce an immune response in the latter cell. In some embodiment, the immune response is in vitro (e.g., a mixed lymphocyte reaction) or can be observed in vivo (e.g., in a subject having the second cell and having received the first cell). The second cell can be located in an immunocompetent subject. Preferably, the immune response is a cell-based immune response in which cellular mediator can be produced. In the context of the present disclosure, the immunogenic cells are immune cells, such as white blood cells or leukocytes.

Immunogenic cell culture conditions. A cell culture is considered to be conducted in immunogenic conditions when it allows the establishment of a pro-inflammatory immune response between two distinct and unmodified leukocytes (and, in an embodiment, when it allows allo-recognition). Preferably, the pro-inflammatory immune response is a cell-based immune response in which cellular mediator can be produced. For example, the cell culture conditions can be those of a mixed lymphocyte reaction (primary or secondary).

Infection. As used in the context of the present disclosure, the term “infection” or “infective disease” is a condition caused by the presence and proliferation of an infectious agent which induces a state of low or repressed immune response (e.g., anergy). In some embodiments, the infection is caused by a parasite and in such instance, it is referred to as a “parasitic” infection. There are mainly three classes of parasites which can cause infections, at least in humans, protozoa (causing a protozoan infection), helminths (causing an helminthiasis) and ectoparasites. As it is known in the art, parasites have the intrinsic ability, upon infecting their host, to upregulate or enhance Treg's levels and/or activity and thereby induce a state of immune tolerance. This is exemplified by filarial nematodes in which the nematode secretes substances that cause an increase in the host's Treg lymphocytes levels. The increase in Tregs actively down-regulate the Th1, Th17 and Th2 responses necessary for eradication of the parasite. Administration of an agent that can reverse the parasite's induced Treg increase would enhance the ability of the subject's immune system to eradicate the parasitic infection. In another embodiment, the infection is caused by a virus (such as, for example, the human immunodeficiency virus or HIV) and, in such instance, it is referred to as a “viral” infection. In some embodiments, the viral infection is an acquired immunodeficiency syndrome or AIDS. In yet another embodiment, the infection is caused by a bacterium (such as, for example, from a Streptococcus sp. (e.g., Streptococcus pneumoniae) and, in such instance, it is referred to as a “bacterial” infection. In some embodiments, the bacterial infection is pneumonia. As it is known in the art, Tregs are implicated in improving clearance and reducing injury due to bacteria/viruses as well as increasing infections in viruses and bacteria. Viral and bacterial infections spread can be facilitated by an overly strong immune response, hence Tregs would reduce this risk. However, elevated Treg, in the absence of a proinflammatory response, would cause a state of immune suppression. In another embodiment, the infection is caused by a fungus and, in such instance, it is referred to as a “fungal” infection. Fungal infections are opportunistic and T cells play a critical role in stimulating the neutrophils which are able to limit or clear the fungal infection. Subjects with a reduced (low or inappropriate) immune response have an increased risk towards fungal infections (e.g., Aspergillus sp. (e.g. Aspergillus histoplasmosis) and Candidia sp. (e.g., Candida albicans)).

Leukocyte. As used herein, a leukocyte (also spelled leucocyte) is defined as a blood cell lacking hemoglobin and having a nucleus. Leukocytes are produced and derived from hematopoietic stem cells. Leukocytes are also referred to as white blood cells. Leukocytes include granulocytes (also known as polymorphonuclear leucocytes), e.g., neutrophils, basophils and eosoniphils. Leukocytes also include agranulocytes (or mononuclear leucocytes), e.g., lymphocytes, monocytes and macrophages. Some of the lymphocytes, referred to as T cells (or T-cell), bear on their surface a T-cell receptor. T cells are broadly divided into cells expressing CD4 on their surface (also referred to as CD4-positive cells) and cells expressing CD8 on their surface (also referred to as CD8-positive cells). Some of the lymphocytes, referred to as B cells (or B-cells), bear on their surface a B-cell receptor.

Low-immunogenic biocompatible polymer. As used herein, a “low-immunogenic polymer” refers to a polymer which is not or is unlikely to elicit an immune response in an individual. This low-immunogenic polymer is also capable, when grafted at the appropriate density, of masking antigenic determinants of a cell and lowering or even preventing an immune response to the antigenic determinant when the antigenic determinant is introduced into a subject. A “biocompatible polymer” refers to a polymer which is non-toxic when introduced into a subject. Exemplary low-immunogenic biocompatible polymers includes, but are not limited to, polyethylene glycol (for example methoxypoly(ethylene glycol)), hyperbranched polyglycerol (HPG), 2-alkyloxazoline (POZ) such as, for example, polyethyloxazoline (PEOZ) (Kyluik-Price D. L. et al. (2014)).

Non-proliferative leukocyte. As used herein, the term “non-proliferative leukocyte” refers to a leukocyte which has been modified to no longer being capable of cellular proliferation (e.g. performing at least one complete division cycle). In some embodiments, this modification may be temporary and the non-proliferative properties of a leukocyte may be limited in time. For example, when a leukocyte is modified from a contact with a pharmacological agent capable of limiting its proliferation, the removal of the pharmacological agent from the cell culture can allow the leukocyte to regain its proliferative properties. In other embodiments, the modification is permanent and the modified leukocyte cannot regain its proliferative properties. For example, when a leukocyte is irradiated, it is not possible for it to regain its proliferative properties. In the context of the present application, the expressions “non-proliferative leukocyte” or “leukocyte limited from proliferating” are used interchangeably.

Peripheral blood mononuclear cells (PBMC). This term refers to the cell population recuperated/derived from the peripheral blood of a subject (usually a mammal such as a human). PBMC usually contains T cells, B cells and antigen presenting cells.

Pharmaceutically effective amount or therapeutically effective amount. These expressions refer to an amount (dose) of an acellular preparation effective in mediating a therapeutic benefit to a patient (for example prevention, treatment and/or alleviation of symptoms of an immune-associated disorder or condition in which the ratio of Tregs to pro-inflammatory T cells is high or low when compared to sex- and aged-matched healthy subjects). It is also to be understood herein that a “pharmaceutically effective amount” may be interpreted as an amount giving a desired therapeutic effect, either taken in one dose or in any dosage or route, taken alone or in combination with other therapeutic agents.

Prevention, treatment and alleviation of symptoms. These expressions refer to the ability of the acellular preparation to limit the development, progression and/or symptomology of an immune-associated disorder. In some embodiments, the immune-associated disorders are conditions caused/exacerbated by a low or inappropriate immune response (also known as a state of anergy or tolerance). The subjects being afflicted with these conditions/disorders have a ratio of Tregs to pro-inflammatory T cells which is considered high when compared to sex- and aged-matched healthy subjects. In such embodiment, the prevention, treatment and/or alleviation of symptoms encompasses decreasing the levels of Treg cells and/or increasing the levels of pro-inflammatory T cells. The acellular-based preparation is considered effective or successful for treating and/or alleviating the symptoms associated with the disorder when a reduction in the pro-tolerogenic state (when compared to an untreated and afflicted individual) in the treated individual (previously known to be afflicted with the disorder) is observed. A method or acellular-based preparation is considered effective or successful for preventing the disorder when a reduction in the pro-tolerogenic state (when compared to an untreated and afflicted individual) in the treated individual is observed upon an immunological challenge (such as, for example, an antigenic challenge).

In another embodiment, the immune-associated disorders are conditions cause/exacerbated by an abnormal/excessive immune response (also known a pathological inflammation). The subjects being afflicted with these conditions/disorders have a ratio of Tregs to pro-inflammatory T cells which is considered low when compared to sex- and age-matched healthy subjects. In such embodiment, the prevention, treatment and/or alleviation of symptoms encompasses increasing the levels of Treg cells and/or decreasing the levels of pro-inflammatory T cells. The acellular preparation is considered effective or successful for treating and/or alleviating the symptoms associated with the disorder when a reduction in the pro-inflammatory state (when compared to an untreated and afflicted individual) in the treated individual (previously known to be afflicted with the disorder) is observed. The acellular-based preparation is considered effective or successful for preventing the disorder when a reduction in the pro-inflammatory state (when compared to an untreated and afflicted individual) in the treated individual is observed. In instances where the conditions to be treated is cancer, exemplary symptoms which can be alleviated with the acellular-based preparations described herewith include, but are not limited to, number and/or size of metastasic tumors, presence and/spread of metastatic tumors and/or size of primary tumor. In instances where the conditions to be treated is an infection, exemplary symptoms which can be alleviated with the acellular-based preparations described herewith include, but are not limited to, infectious agent's burden, infectious agent's presence and fever.

Pro-inflammatory T cells. In the present context, pro-inflammatory T cells are a population of T cells capable of mediating an inflammatory reaction. Pro-inflammatory T cells generally include T helper 1 (Th1 or Type 1) and T helper 17 (Th17) subsets of T cells. Th1 cells partner mainly with macrophage and can produce interferon-γ, tumor necrosis factor-β, IL-2 and IL-10. Th1 cells promote the cellular immune response by maximizing the killing efficacy of the macrophages and the proliferation of cytotoxic CD8+ T cells. Th1 cells can also promote the production of opsonizing antibodies. T helper 17 cells (Th17) are a subset of T helper cells capable of producing interleukin 17 (IL-17) and are thought to play a key role in autoimmune diseases and in microbial infections. Th17 cells primarily produce two main members of the IL-17 family, IL-17A and IL-17F, which are involved in the recruitment, activation and migration of neutrophils. Th17 cells also secrete IL-21 and IL-22.

Proliferation-associated disorders. These disorders (also referred to as hyperproliferative disorders) form a class of diseases where cells proliferate more rapidly, and usually not in an ordered fashion, than corresponding healthy cells. The proliferation of cells causes an hyperproliferative state that may lead to biological dysfunctions, such as the formation of tumors (malignant or benign). One of the proliferation-associated disorders is cancer. Also known medically as a malignant neoplasm, cancer is a term for a large group of different diseases, all involving unregulated cell growth. In cancer, cells divide and grow uncontrollably, forming malignant tumors, and invade nearby parts of the body. The cancer may also spread to more distant parts of the body through the lymphatic system or bloodstream. In an embodiment, the cancer is a carcinoma (e.g. a cancer of the epithelial cells). Other types of cancer include, but are not limited to sarcoma, lymphoma, leukemia, germ cell tumor and blastoma.

Regulatory T cells. Regulatory T cells are also referred to as Treg and were formerly known as suppressor T cell. Regulatory T cells are a component of the immune system and suppress immune responses of other cells. Regulatory T cells usually express CD3, CD4, CD8, CD25, and Foxp3. Additional regulatory T cell populations include Tr1, Th3, CD8⁺CD28⁻, CD69⁺, and Qa-1 restricted T cells. It has been recently shown that CD69 can exert regulatory function in the immune response by preventing pro-inflammatory conditions. Under normal conditions, this regulatory effect of CD69 is desired, but when expressed in the context of a pro-inflammatory response to, for example, a tumor cell mass, will result in impaired killing of the abnormal cells and disease progression. Regulatory T cells actively suppress activation of the immune system and prevent pathological self-reactivity, i.e. autoimmune disease. The critical role regulatory T cells play within the immune system is evidenced by the severe autoimmune syndrome that results from a genetic deficiency in regulatory T cells. The immunosuppressive cytokines TGF-β and Interleukin 10 (IL-10) have also been implicated in regulatory T cell function. Similar to other T cells, a subset of regulatory T cells can develop in the thymus and this subset is usually referred to as natural Treg (or nTreg). Another type of regulatory T cell (induced Treg or iTreg) can develop in the periphery from naïve CD4⁺ T cells. The large majority of Foxp3-expressing regulatory T cells are found within the major histocompatibility complex (MHC) class II restricted CD4-expressing (CD4⁺) helper T cell population and express high levels of the interleukin-2receptor alpha chain (CD25). In addition to the Foxp3-expressing CD4⁺CD25⁺, there also appears to be a minor population of MHC class I restricted CD8⁺ Foxp3-expressing regulatory T cells. Unlike conventional T cells, regulatory T cells do not produce IL-2 and are therefore anergic at baseline. Moreover, regulatory T cell produce elevated levels of IL-10 and TGF-β which inhibit pro-inflammatory responses An alternative way of identifying regulatory T cells is to determine the DNA methylation pattern of a portion of the foxp3 gene (TSDR, Treg-specific-demethylated region) which is found demethylated in Tregs.

Splenocytes. This term refers to the cell population obtained from the spleen of a subject (usually a mammal such as a rodent). Splenocytes usually comprise T cell, B cell as well as antigen presenting cells.

Syngeneic cell. A cell is considered “syngeneic” with respect to a subject (or a cell derived therefrom) if it is sufficiently identical to the subject so as to prevent an immune rejection upon transplantation. Syngeneic cells are derived from the same animal species.

Viable. In the present context, the term “viable” refers to the ability of a cell to complete at least one cell cycle and, ultimately proliferate. A viable cell is thus capable of proliferating. By opposition, the term “non-viable” or “non-proliferative” both refer to a cell which is no longer capable of completing at least one cell cycle. By comparison, the term “cycle arrest” refers to a cell which has been treated to halt its cell cycle progression (usually with a pharmacological agent) but which is still capable of re-entering the cell cycle (usually when the pharmacological agent is removed).

Xenogeneic cell. A cell is considered “xenogeneic” with respect to a subject (or a cell derived from the subject) when it is derived from a different animal species than the subject. A xenogeneic cell is expected to be rejected when transplanted in an immunocompetent host.

BRIEF DESCRIPTION OF THE DRAWINGS

Having thus generally described the nature of the invention, reference will now be made to the accompanying drawings, showing by way of illustration, a preferred embodiment thereof.

FIGS. 1A to C illustrate the effects of size (MW) separation and RNase treatment on the immunomodulary effects of acellular preparations. Unmodified conditioned murine plasma (obtained from donor mice 5 days post splenocyte transfer), size fractionated-conditioned murine plasma or RNase-treated conditioned murine plasma was administered once to naïve mice and Treg/Th17 levels were measured (when) in the spleen. (A) Results are shown as the percentage of Th17 cells (in function of CD4⁺ cells) in function of type of conditioned medium (white bars=conditioned plasma obtained from administering saline, hatched bars=conditioned plasma obtained from administering unmodified allogeneic splenocytes, grey bars=conditioned plasma obtained from administering polymer-modified allogeneic splenocytes) and size fractionation (non-fractioned or complete conditioned serum, fraction >100 kDa, fraction between 30 and 100 kDa, fraction between 10 and 30 kDa, fraction <10 kDa). a denotes the mean value for unfractionated conditioned medium prepared from mice previously treated with unmodified allogeneic cells. b denotes the mean value for unfractionated conditioned medium prepared from mice previously treated with mPEG-modified allogeneic cells. (B) Results are shown as the percentage of Treg cells (in function of CD4⁺ cells) in function of type of conditioned medium (white bars=conditioned plasma obtained from administering saline, hatched bars=conditioned plasma obtained from administering unmodified allogeneic splenocytes, grey bars=conditioned plasma obtained from administering polymer-modified allogeneic splenocytes) and size fractionation (non-fractioned or complete conditioned serum, fraction >100 kDa, fraction between 30 and 100 kDa, fraction between 10 and 30 kDa, fraction <10 kDa). a denotes the mean value for unfractionated conditioned medium prepared from mice previously treated with unmodified allogeneic cells. b denotes the mean value for unfractionated conditioned medium prepared from mice previously treated with mPEG-modified allogeneic cells. (C) Results are shown as the percentage of Treg cells (in function of CD4⁺ cells, left panel) or Th17 cells (in function of CD4⁺ cells, right panel) in function of type of treatment (white bars=N=naïve untreated animals; grey bars=AC=unmodified allogeneic cells; diagonal hatch bars=conditioned plasma obtained from administered unmodified splenocytes treated (allo-plasma (+)) or not (allo-plasma (−)) with RNase; horizontal hatch bars=conditioned plasma obtained from administering polymer modified splenocytes treated (mPEG-allo-plasma (+)) or not (mPEG-allo-plasma (−)) with RNase.

FIGS. 2A to C illustrate the cellular modulation in Treg cells upon the administration of condition murine plasma. Saline, unmodified conditioned plasma (obtained by administering saline to the animal, identified as plasma(saline)), conditioned plasma obtained from the administration of non-modified allogeneic cells (identified as plasma (allo)) or the conditioned plasma obtained from the administration of polymer-modified allogeneic cells (identified as plasma (mPEG-Allo)) was injected once (1) or thrice (3) in the animals. After 5 days, the animals were sacrificed and their spleen and brachial lymph nodes were obtained. (A) Results are shown as the percentage of CD4⁺CD25⁺ T cells in function of type of conditioned plasma administered in the spleen (white bars) and in the brachial lymph nodes (grey bars). * denotes p<0.001 relative to treatment with conditioned plasma from mice treated with saline, # denotes p<0.001 relative to treatment with conditioned medium derived from mice treated with unmodified allogeneic splenocytes. (B) Results are shown as the percentage of CD69⁺CD4⁺CD25⁻ T cells in function of type of conditioned plasma administered in the spleen (white bars) and in the brachial lymph nodes (grey bars). * denotes p<0.001 relative to treatment with conditioned plasma from mice treated with saline, # denotes p<0.001 relative to treatment with conditioned medium derived from mice treated with unmodified allogeneic splenocytes. (C) Results are shown as the percentage of Foxp3⁺, CD25⁺ or CD69⁺ of CD4⁺ cells in function of the conditioned plasma administered in splenic cells (white bars) and lymph node cells (gray bars).

FIGS. 3A to E illustrate the size fractionated conditioned plasma on the intracellular expression of cytokines. Unmodified conditioned murine plasma (obtained from donor mice 5 days post saline or splenocyte transfer), size fractionated-conditioned murine plasma was administered once to naïve mice and Treg/Th17 levels were measured (when) in the spleen. Results are shown as the percentage intracellular cytokine positive CD4⁺ cells in function of type of conditioned medium (white bars=conditioned plasma obtained from administering saline, hatched bars=conditioned plasma obtained from administering unmodified allogeneic splenocytes, grey bars=conditioned plasma obtained from administering polymer modified allogeneic splenocytes) and size fractionation (non-fractioned or complete conditioned serum, fraction >100 kDa, fraction between 30 and 100 kDa, fraction between 10 and 30 kDa, fraction <10 kDa) for (A) IL-10, (B) IL-2, (C) IFN-γ, (D) TNF-α and (E) IL-4. * denotes p<0.001 relative to treatment with conditioned plasma from mice treated with saline, # denotes p<0.001 relative to treatment with conditioned medium derived from mice treated with unmodified allogeneic splenocytes.

FIGS. 4A to E illustrates the in vivo effects of the various conditioned medium and preparations derived therefrom on the intracellular expression of cytokines as well as type of CD4⁺ cells. Conditioned plasma was obtained by administering naïve mice with saline, unmodified allogeneic splenocytes or polymer-modified allogeneic splenocytes (PEG) and recuperating plasma after 5 days. The obtained plasma was either administered directly (●=untreated) or optionally treated with RNaseA (∘ =conditioned plasma, ▪=miRNA enriched fraction of conditioned plasma) and/or further purified so as to retain and enrich the <10 kDa fraction (e.g. miRNA) (▪=untreated miRNA, □=RNase A-treated miRNA) prior to administration. As a control, RNase A was also administered directly to some animals. After 30, 60, 120, 180, 270 days, animals were sacrificed, their spleen was removed and CD4⁺ cells were characterized by flow cytometry. Results are shown for intracellular cytokine expression: IL-2 (A), INF-γ (B), IL-10 (C), as well as CD4⁺ cell type: Treg (Foxp3⁺) (D) and Th17 (IL-17⁺) (E) CD4⁺ cells.

FIGS. 5A to D illustrates the effects of the TA and IA preparations on the phosphorylation of phosphokinases of resting Jurkat cells. Results are shown as fold modulation (when compared to saline-treated Jurkat cells) for each kinase tested. Results for TA preparations are shown in panels (A) to (C). Comparative results between TA and IA preparations are shown in panels (D). (A) On this panel, Akt is considered to be significantly increasingly phosphorylated in the presence of the TA1 preparation. (B) On this panel, PRAS40 is considered to be significantly increasingly phosphorylated, in the presence of the TA1 preparation. (C) On this panel, HSP60 is considered to be significantly decreasingly phosphorylated, in the presence of the TA1 preparation. (D) On this panel, it can be seen that the phosphorylation of kinases HSP60, WNK1, STAT3, RSK1/2/3, p53 and Akt are inversely modulated in the presence of TA1 preparations (white bars) and IA preparations (grey bars). * denotes greater than 10-fold increase in protein phosphorylation over resting Jurkat cells. # denotes greater than 10-fold decrease in protein phosphorylation over resting Jurkat cells.

FIG. 6 illustrates the in vitro effects of the murine IA1 preparations on human PBMCs. Murine TA1 or IA1 preparations (either 25 μL, 50 μL, 100 μL or 200 μL) were included in a human PBMC MLR assay and cellular proliferation was measured. Results are shown as percent in proliferation (CD3⁺CD4⁺ cells) in function of conditions (Rest=resting MLR, MLR=conventional MLR without TA1, Murine TA-1=MLR with TA1, Murine IA-1=MLR with IA1) and TA1/IA1 concentration (in μL) after 10 days (A) or 14 days (B). # denotes p<0.001 relative to conventional MLR value and and * denotes p<0.001 relative to murine IA1 MLR. ¢ denotes the concentration of the TA1 or IA1 preparation used in the in vivo mouse study (e.g., FIG. 7).

FIGS. 7A to D illustrates the in vivo effects of the sequential combined use of murine TA1 and IA1 preparations on the level of Teg and Th17 cells. Naïve animals were divided in two groups: those receiving a single type of preparation (Saline, AI1 or TA1 preparations) and those receiving two types of preparations (1° TAI/2° IA1 or 1° IA1/2° TA1). All animals were administered thrice (at day 0, 2 and 4) with saline, the TA1 preparation or the IA1 preparation. Animals receiving a second preparation were administered thrice (at day 9, 11 and 13) with the IA1 or the TA1 preparation. At day 40, all animals were sacrificed and the lymphocytes in their spleen and brachial lymph node were characterized. In (A) and (B), results are shown as the percentage of Treg cells (with respect to the total number of CD4⁺ cells) in function of treatment in the spleen (A) and the brachial lymph nodes (B). Δd refers to the increase in Treg cell levels between naïve animals and those having received TA1 preparations. Δd′ refers to the decrease in Treg cell levels between naïve animals and those having received IA1 preparations. Δd′^(2o) refers to the decrease in Treg cell levels between animals having received only TA1 preparations and those having received TA1 preparations followed by IA1 preparations. Δd^(2o) refers to the increase in Treg cell levels between animals having received only IA1 preparations and those having received IA1 preparations followed by TA1 preparations. The gray zone in this figure indicates naïve Treg levels. The dashed lines indicate the maximal Treg levels (obtained with TA1 preparations) and minimal Treg level (obtained with IA1 preparations). In (C) and (D), results are shown as the percentage of Th17 cells (with respect to the total number of CD4⁺ cells) in function of treatment in the spleen (C) and the brachial lymph nodes (D). Δd refers to the decrease in Th17 cell levels between naïve animals and those having received TA1 preparations. Δd′ refers to the increase in Th17 cell levels between naïve animals and those having received IA1 preparations. Δd′^(2o) refers to the increase in Th17 cell levels between animals having received only TA1 preparations and those having received TA1 preparations followed by IA1 preparations. Δd^(2o) the decrease in Th17 cell levels between animals having received only IA1 preparations and those having received IA1 preparations followed by TA1 preparations. The gray zone in this figure indicates naïve Th17 levels. The dashed lines indicate the minimal Th17 levels (obtained with TA1 preparations) and maximal Th17 level (obtained with IA1 preparations).

FIGS. 8A to 8C provide a comparison of the miRNA populations between different MLR assays. A human PBMC MLR assay (using unmodified (control MLR) or polymer modified leukocyte (mPEG MLR)) was conducted and miRNA content was partially determined. Volcano plots of comparing the miRNA population of the conditioned medium of the control MLR to the one of the supernatant of resting cells (A), comparing the miRNA population of the conditioned medium of a mPEG MLR to the one of the supernatant of resting cells (B) and comparing the miRNA population of the conditioned medium of a mPEG MLR to the one of the conditioned medium of a control MLR (C) are provided. Results are provided in −Log₁₀ (p value) in function of Log₂ fold change. In these volcano plots, the following miRNAs have been identified with numbers:

-   -   1 has-miR-298     -   2 has-miR-34a-5p     -   3 has-miR-574-3p     -   4 has-miR-125b-5p     -   5 has-let-7a-5p     -   6 has-miR-196a-5p     -   7 has-miR-148a-3p     -   8 has-let-7e-5p     -   9 has-miR-134

FIG. 9 provides a partial miRNA compositional analysis of the conditioned medium of a mPEG MLR (white bars) and of a control MLR (black bars). Results are provided, for each miRNA, as log₂ fold regulation when compared to the miRNA present in the supernatant of resting cells. White open stars denote Log₂-fold change and black solid stars denote significant changes in volcano plot analysis.

FIG. 10 provides a selection of the miRNA compositional analysis of the conditioned medium of a mPEG MLR (white bars) and of a control MLR (black bars). Results are provided, for each miRNA, as log₂ fold regulation when compared to the miRNA present in the supernatant of resting cells. White open stars denote Log₂-fold change and black solid stars denote significant changes and or clustergram (heatmap) determined miRNA shifts denoted in volcano plot analysis.

DETAILED DESCRIPTION

In accordance with the present disclosure, there is provided a therapeutic combination for modulating the level of regulatory T cells and/or the level of pro-inflammatory T cells for ultimately intentionally inducing immune modulation in a subject in need thereof. The acellular-based pro-inflammatory preparations are obtained by contacting at least two distinct leukocyte populations which are considered allogeneic with respect to one another. The therapeutic combinations described herein comprise at least one acellular pro-inflammatory preparation and at least one acellular pro-tolerogenic preparation. The pro-inflammatory preparation can be obtained by contacting the two allogeneic leukocyte populations under conditions to allow pro-inflammatory allo-recognition but to limit or prevent pro-tolerogenic recognition. The pro-tolerogenic preparations can be obtained by contacting the two allogeneic leukocyte populations under conditions to allow pro-tolerogenic allo-recognition but to limit or prevent pro-inflammatory recognition. In the process for making the pro-tolerogenic preparation, one of the two leukocyte population has been modified with a polymer. For either acellular preparations, the contact between the two types of leukocytes can occur in vitro, ex vivo or in vivo. The biological fluid (cell culture medium or fraction thereof, blood, blood fraction) in which the two types of leukocytes have been contacted is then recuperated in RNase-free conditions and can be used, without further purification to induce an immune modulation.

Since the acellular preparations can optionally be enriched in miRNAs, it is important that the cell culture and/or the blood/blood fraction be processed in conditions so as to retain the integrity of the majority of the miRNA species present, for example by substantially inhibiting RNA degradation. As used herein, the term “substantially inhibiting RNA degradation” indicate that the conditions allow for the degradation of less than 20%, 19%, 18%, 17%, 16%, 15%, 14%, 13%, 12%, 11%, 10%, 9%, 8%, 7%, 6% or 5% of the miRNA population obtained by RNases. RNases include, but are not limited endoribonucleases (e.g., RNase A, RNase H, RNase I, RNase III, RNase L, RNase P, RNase PhyM, RNase T1, RNase T2, RNase U2, RNase V1 and/or RNase V) and exoribonucleases (e.g., polynucleotide pPhosphorylase (PNPase), RNase PH, RNase II, RNase R, RNase D, RNase T, Oligoribonuclease, Exoribonuclease I and/or Exoribonuclease II). Since it is known in the art that miRNAs are, in general, more resistance towards degradation than messenger RNAs, the conditions for obtaining and processing the cell culture/blood can allow for some RNA degradation, preferably limited to the mRNA fraction.

As it will be shown below, acellular preparations obtained from allogeneic leukocytic cells provides a significant opportunity to modulate the responsiveness (i.e., immunoquiescent versus pro-inflammatory) of the recipient's immune system. The therapeutic combinations described herein can be used to intentionally induce a pro-tolerogenic state in an afflicted subject and, afterwards, provide immune stimulation to the same subject. Optionally, the therapeutic combination can also be used to intentionally re-induce a pro-tolerogenic state in the same subject. Alternatively, the therapeutic combinations described herein can be used to intentionally induce a pro-inflammatory state in an afflicted subject and, afterwards, provide immune tolerance to the same subject. Optionally, the therapeutic combination can also be used to re-induce a pro-inflammatory state in the same subject.

Therapeutic Combinations and Associated Therapeutic Kits

The therapeutic combinations described herein comprise at least one pro-tolerogenic acellular preparation and at least one pro-inflammatory acellular preparation. The pro-tolerogenic acellular preparation and the pro-inflammatory acellular preparation are not to be administered in a simultaneous manner, but in a sequential manner. A first preparation can be administered to the afflicted subject (e.g., which, in an embodiment, is naïve to the acellular pro-tolerogenic and/or pro-inflammatory preparations described herein) to modulate his initial Tregs/pro-inflammatory T cells ratio (e.g., which has been determined to be associated with an immune disorder) to a first Tregs/pro-inflammatory T cells ratio (e.g., believed to be beneficial for preventing, treating or alleviations the symptoms associated with an immune disorder). The second preparation can then administered afterwards either to achieve a second Tregs/pro-inflammatory T cell ratio (e.g., usually between the initial ratio and the first ratio) or to revert back to the initial Tregs/pro-inflammatory T cells ratio (of the naïve subject). Optionally, the therapeutic combinations described herein can also comprise a third preparation for achieving a third Treg/pro-inflammatory T cell ratio.

In some embodiments, the acellular pro-tolerogenic preparation is adapted to initially be administered to the subject in need thereof prior to the administration of the acellular pro-inflammatory preparation. In such instance, a first state of immune tolerance is induced in the treated subject (by the administration of a first dose or multiple doses of the acellular pro-tolerogenic preparation) and then, when it is determined that a further increase in the immune response is warranted, an immune stimulation is then induced in the treated subject (by the administration of a first dose or multiple doses of the acellular pro-inflammatory preparation). It is possible that, in some situations, it is warranted to return to an increased state of tolerance in the treated subject after the onset of an immune stimulation. In such instance, a further state of immune tolerance can be induced by the administration of a second dose (or multiple doses) of the acellular pro-tolerogenic preparation to the treated subject. In still further embodiments, it is possible to induce a further state of immune stimulation to the treated subject by administering a second dose (or a second round of doses) of the acellular pro-inflammatory preparation. As such, it is possible to provide a therapeutic combination comprising at least two, at least three, at least four, at least five or more doses of the acellular pro-tolerogenic preparations and at least one, at least two, at least three, at least four, at least five or more of the acellular pro-inflammatory preparation that are being to be administered in a sequential manner. In one embodiment, the acellular pro-tolerogenic preparations are administered in an alternate fashion with the acellular pro-inflammatory preparations. In another embodiment, more than one dose of the acellular pro-tolerogenic preparation are first administered sequentially and then, at least one dose (or more than one dose) of the pro-inflammatory preparation(s) is(are) administered.

In other embodiments, the acellular pro-inflammatory preparation is adapted to be initially administered to the subject in need thereof prior to the administration of the acellular pro-tolerogenic preparation. In such instance, a first state of immune stimulation is induced in the treated subject (by the administration of a first dose or multiple doses of the acellular pro-inflammatory preparation) and then, when it is determined that a decrease in the immune response is warranted, an immune tolerance state is then induced in the treated subject (by the administration of one or more doses the acellular pro-tolerogenic preparation). It is possible that, in some situations, it is warranted to return to an increased state of stimulation in the treated subject after the onset of an immune tolerance. In such instance, a further state of immune stimulation is induced by the administration of a second dose (or multiple doses) of the acellular pro-inflammatory preparation to the treated subject. In still further embodiments, it is possible to induce a further state of immune tolerance to the treated subject by administering a second dose of the acellular pro-tolerogenic preparation. As such, it is possible to provide a therapeutic combination comprising at least two, at least three, at least four, at least five or more doses of the acellular pro-inflammatory preparations and at least one, at least two, at least three, at least four, at least five or more of the acellular pro-tolerogenic preparation that are being to be administered in a sequential manner. In one embodiment, the acellular pro-inflammatory preparations are administered in an alternate fashion with the acellular pro-tolerogenic preparations. In another embodiment, more than one dose of the acellular pro-inflammatory preparation are first administered sequentially and then, at least one dose (or more than one dose) of the pro-tolerogenic preparation(s) is(are) administered.

The present disclosure also provides therapeutic kits comprising the therapeutic combinations described herein. The therapeutic kit comprises at least one, at least two, at least three, at least four, at least five or more doses of the acellular pro-tolerogenic described herein, at least one, at least two, at least three, at least four, at least five or more doses of the acellular pro-inflammatory preparation described herein as well as instructions for using the acellular pro-tolerogenic preparations and the acellular pro-inflammatory preparations in a sequential and, optionally alternate, manner. The instructions can specify, for example, that the acellular pro-tolerogenic preparation is initially to be administered to the subject prior to the administration of the acellular pro-inflammatory preparation. Alternatively, the instructions can specify that the acellular pro-inflammatory preparation is initially to be administered to the subject prior to the acellular pro-tolerogenic preparation. The therapeutic kits can also provide distinct containers for each acellular preparation to avoid the physical contact between each type of preparations (e.g. pro-tolerogenic vs. pro-inflammatory) or each dose of the same type of preparations. The therapeutic kits can also provide means for administering the preparations to the subject, such as, for example, means for delivering intravenously the preparations (such as syringes). In some embodiments, the therapeutic kits can provide a syringe for each dose of acellular preparation that needs to be administered.

The preparations of the therapeutic kits can be formulated in a freeze-dried form destined to be reconstituted with a pharmaceutically acceptable excipient (such as a physiological saline solution). Alternatively, the preparations of the therapeutic kits can be formulated in a solution which would stabilize or limit miRNA degradation (e.g., ethanol for example) destined to be diluted with a pharmaceutically acceptable excipient (e.g., saline for example). The therapeutic kits can also comprise the pharmaceutically acceptable excipient for reconstituting the freeze-dried preparations or for diluting the solution containing the preparations, optionally divided into pre-measured volumes for reconstituting/diluting a single preparation.

The therapeutic kits can also comprise other components which would allow to determine the ratio in the level of regulatory T (Treg) cells to the level of pro-inflammatory T cells in the subject intended to be treated. For example, the therapeutic kits can comprise a first set of labeled (e.g., fluorescent tagged) antibodies to detect the number of Treg cells (eg., anti-CD25, anti-CD69 and/or anti-FoxP3⁺ antibodies) cells and a second set of labeled (e.g., fluorescent tagged) antibodies to detect pro-inflammatory T cells (e.g., Th17 or Th1). The therapeutic kits could also comprise anti-CD4 antibodies to determine the number of CD4⁺ T cells (Treg and pro-inflammatory T cells) in the sample obtained from the subject intended to be treated. In yet another embodiment, the kit could contain an algorithm card to determine the immune state of the subject (e.g., pro-inflammatory vs. pro-tolerogenic) or how much of the pro-inflammatory or pro-tolerogenic preparations need to be administered to the subject in order to achieve the desired therapeutic target.

(i) Process for Obtaining the Acellular Pro-tolerogenic Preparation

The acellular pro-tolerogenic preparations presented described herein can be obtained by contacting two distinct and allogeneic leukocyte populations (referred herein to the first leukocyte and the second leukocyte). The two leukocyte populations are contacted under conditions so as to allow (and in some embodiments to favor) pro-tolerogenic allo-recognition and to prevent (and in some embodiments to inhibit) pro-inflammatory allo-recognition.

Prior to the contact between the leukocyte populations, at least one of the first and/or the second leukocyte is modified to bear on their surface a low-immunogenic polymer. It is important that the polymer added or the conditions used to graft the polymer do not significantly alter the ability of the two leukocyte populations to mediate a pro-tolerogenic allo-recognition. It is important that the polymer used exhibits both low-immunogenicity and biocompatibility once introduced into a cell culture system or administered to the test subject. Polyethylene glycol (particularly methoxypoly(ethylene glycol)), 2-alkyloxazoline (POZ) such as, for example and polyethyloxazoline (PEOZ) and hyperbranched polyglycerol (HPG) are exemplary polymers which all exhibit low immunogenicity and biocompatibility and can be successfully used to modify the first leukocyte (and optionally the second leukocyte). In some embodiments, it is preferable to use a single type of polymer to modify the surface of leukocytes. In other embodiments, it is possible to use at least two distinct types of polymers to modify the surface of the leukocyte.

In an embodiment, the low-immunogenic biocompatible polymer can be covalently associated with the membrane-associated protein(s) of the leukocyte by creating a reactive site on the polymer (for example by deprotecting a chemical group) and contacting the polymer with the leukocyte. For example, for covalently binding a methoxypoly(ethylene glycol) to the surface of a leukocyte, it is possible to incubate a methoxypoly(-ethylene glycol) succinimidyl valerate (reactive polymer) in the presence of the leukocyte. The contact between the reactive polymer and the leukocyte is performed under conditions sufficient for providing a grafting density which will allow pro-tolerogenic allo-recognition and prevent pro-inflammatory allo-recognition. In an embodiment, the polymer is grafted to a viable leukocyte and under conditions which will retain the viability of the leukocyte. A linker, positioned between the surface of the leukocyte and the polymer, can optionally be used. Examples of such polymers and linkers are described in U.S. Pat. Nos. 5,908,624; 8,007,784 and 8,067,151. In another embodiment, the low-immunogenic biocompatible polymer can be integrated within the lipid bilayer of the cytoplasmic membrane of the leukocyte by using a lipid-modified polymer.

As indicated above, it is important that the low-immunogenic biocompatible polymer be grafted at a density sufficient allowing pro-tolerogenic allo-recognition while preventing pro-inflammatory allo-recognition of the first leukocyte by the second leukocyte (and vice versa). In an embodiment, the polymer is polyethylene glycol (e.g., linear) and has an average molecular weight between 2 and 40 KDa as well as any combinations of molecular weight within this range. In another embodiment, the polymer is polyethylene glycol (e.g. linear) and has an average molecular weight between 2 and 40 KDa as well as any combinations of molecular weight within this range. In a further embodiment, the average molecular weight of the PEG to be grafted is at least 2, 3, 4, 5, 10, 15, 20, 25, 30, 35 or 40 kDa. In another embodiment, the average molecular weight of the PEG to be granted is no more than 40, 35, 30, 25, 20, 15, 10, 5, 4, 3, or 2 kDa. In another embodiment, the grafting concentration of the polymer (per 20×10⁶ cells) is no more than 5.0, 4.5, 4.0, 3.5, 3.0, 2.5, 2.4, 2.0, 1.0, 0.5, 0.4, 0.3, 0.2, 0.1, 0.05, 0.01 or 0.005 mM. In still another embodiment, the grafting concentration of the polymer (per 20×10⁶ cells) is equal to or lower than 0.005, 0.01, 0.05, 0.1, 0.2, 0.3, 0.4, 0.5, 1.0, 2.0, 2.4, 2.5, 3.0, 3.5, 4.0, 4.5 or 5.0 mM. In embodiments where the polymer is grafter to affect the viability of the leukocyte (for example by creating cellular instability, cellular fragmentation or vesiculization, the concentration of the polymer (per 20×10⁶ cells) is equal to or higher than 10 mM. In order to determine if pro-inflammatory allo-recognition occurs, various techniques are known to those skilled in the art and include, but are not limited to, a standard mixed lymphocyte reaction (MLR), high molecular weight mitogen stimulation (e.g. PHA stimulation) as well as flow cytometry (Chen and Scott, 2006). In order to determine if a pro-tolerogenic allo-recognition occurs, various techniques are known to those skilled in the art and include, but are not limited to, the assessment of the level of expansion and differentiation of Treg cells and or prevention of Th17 expansion/differentiation.

Before or after being modified with a low-immunogenic and biocompatible polymer, the first leukocyte can optionally be modified to refrain from being proliferative. This modification preferably occurs prior to its introduction in a cell culture system or its administration into a test subject. For example, the leukocyte can be irradiated (e.g. γ-irradiation) prior to its introduction in a cell culture system or in the test subject. Upon irradiation, the leukocyte is not considered viable (e.g. capable of proliferation). In an embodiment, polymer grafting can affect the leukocyte viability and be used to refrain the leukocyte from proliferating. Alternatively, leukocyte can be treated with a pharmacological agent capable of halting cell cycle progression. Upon the administration of such pharmacological agent, the leukocyte is considered viable since it can resume cellular proliferation when the agent is removed from the cell-containing medium.

It is also contemplated that the second leukocyte (which can optionally be modified with the low-immunogenic and biocompatible polymer) be also optionally modified to refrain from being proliferative. For example, the leukocyte can be irradiated (e.g. γ-irradiation) prior to its introduction in a cell culture system or in the test subject. Upon irradiation, the leukocyte is not considered viable (e.g. capable of proliferation). In an embodiment, polymer grafting can affect the leukocyte viability and can be used to refrain the leukocyte from proliferating. Alternatively, leukocyte can be treated with a pharmacological agent capable of halting cell cycle progression. Upon the administration of such pharmacological agent, the leukocyte is considered viable since it can resume cellular proliferation when the agent is removed from the cell-containing medium. However, when the second leukocyte is modified from being proliferative, it is important the first leukocyte with which it is being contacted remains proliferative.

In order to generate the acellular pro-tolerogenic preparations, it is not necessary to provide homogeneous leukocyte populations. For example, the first leukocyte population (such as, for example a PBMCs or splenocytes) can be introduced in a cell culture system and contacted with a second leukocyte population (such as, for example a PBMCs or splenocytes) or administered to the test subject. However, in some embodiments, it is possible to provide and contact more homogeneous leukocyte populations. For example, the first leukocyte population can be relatively homogenous (such as, for example, a T cell population) and introduced in a cell culture system comprising a second leukocyte population (such as, for example a PBMC or splenocyte) or administered to the test subject. In another example, the first leukocyte population (such as, for example a PBMC or splenocyte) can be introduced in a cell culture system comprising a second leukocyte population which can be relatively homogeneous (such as, for example, a T cell population). In a further example, the first leukocyte population can be relatively homogenous (such as, for example, a T cell population) and introduced in a cell culture system comprising a second leukocyte population which can be relatively homogeneous (such as, for example, a T cell population).

To provide the acellular pro-tolerogenic preparations described herewith, the leukocytes used can be mature leukocytes or be provided in the form of stem cells (e.g., for example non-embryonic stem cells). For example, leukocytes can be obtained from isolating peripheral blood mononuclear cells (PBMC) from the subject. Optionally, the PBMCs can be differentiated in vitro into dendritic (DC) or DC-like cells. Alternatively, the leukocytes can be obtained from the spleen (e.g., splenocytes). Leukocytes usually include T cells, B cells and antigen presenting cells. In some embodiments, cells of sufficient antigenic variation and immunogenicity are used. In addition, for providing the acellular pro-tolerogenic preparations, the leukocytes but not erythrocytes are necessary since the polymer-modified erythrocytes are not capable of eliciting a pro-tolerogenic allo-recognition when administered in a test subject. However, traces of erythrocytes in the leukocyte population used are tolerated (for example, less than about 10%, less than about 5% or less than about 1% of the total number of cells in the preparation).

Even though it is not necessary to further purify the leukocytes to provide the acellular pro-tolerogenic preparations, it is possible to use a pure cell population or a relatively homogenous population of cells as leukocytes. This “pure” cell population and “relative homogenous population” of cells can, for example, essentially consist essentially of a single cell type of T cells, B cells, antigen presenting cells (APC) or stem cells. Alternatively, the population of cells can consist essentially of more than one cell type. The population of cells can be obtained through conventional methods (for example cell sorting or magnetic beads). In an embodiment, when the population of cells consist of a single cell type (for example, T cells), the percentage of the cell type with respect to the total population of cells is at least 90%, at least 95% or at least 99%. The relatively homogenous population of cells is expected to contain some contaminating cells, for example less than 10%, less than 5% or less than 1% of the total population of cells.

The first leukocyte and/or second leukocyte can be obtained from any animals, but are preferably derived from mammals (such as, for example, humans and mice). In an embodiment, the first or second leukocyte can be obtained from a subject intended to be treated with the acellular pro-tolerogenic preparation.

The first and/or second leukocyte can be expanded in vitro prior to the introduction in a cell culture system or the administration to a test subject.

As indicated above, the first and second leukocytes are contacted under conditions to allow pro-tolerogenic allo-recognition (e.g. expansion of Treg cells and/or differentiation of naïve T cells in Treg cells) and prevent/inhibit pro-inflammatory allo-recognition (e.g. expansion of pro-inflammatory T cells and/or differentiation of naïve T cells in pro-inflammatory T cells). When the contact occurs in vitro, it is important that the first leukocyte and the second leukocyte be cultured under conditions allowing physical contact between the two leukocyte populations and for a time sufficient to provide a conditioned pro-tolerogenic medium. As used herein, a conditioned pro-tolerogenic medium refers to physical components of a cell culture (or fraction thereof, such as the cell culture supernatant) obtained by contacting the first and the second leukocyte and having the pro-tolerogenic properties described herein. Usually, the conditioned medium is obtained at least 24 hours after the initial contact between the first and second leukocyte. In some embodiments, the conditioned pro-tolerogenic medium is obtained at least 48 hours or at least 72 hours after the initial contact between the first and the second leukocyte. In an embodiment, the conditioned pro-tolerogenic medium can be obtained after at least 24 hours of incubating the first leukocyte with the second leukocyte. When the incubation takes place in a 24-well plate, the concentration of each leukocyte population can be, for example, at least 1×10⁶ cells.

When the contact occurs in vivo, it is important that the first leukocyte be administered to an immune competent test subject (bearing the second leukocyte) and that the blood or blood fraction be obtained at a later a time sufficient to provide a conditioned pro-tolerogenic blood. The test subject is a subject being immune competent and having a Treg/pro-inflammatory ratio which is substantially similar to age- and sex-matched healthy subjects. As used herein, the conditioned pro-tolerogenic blood refers to physical components present in the blood (or fraction thereof, such as the plasma) obtained by administering the first leukocyte to the immune competent test subject and having the pro-tolerogenic properties described herein. It is recognized by those skilled in the art that the conditioned pro-tolerogenic blood may be obtained more rapidly by increasing the amount of leukocytes being administered or administering more than once (for example one, twice or thrice) the first leukocyte. Usually, the conditioned pro-tolerogenic blood can be obtained at least one day after the administration of the first leukocyte. In some embodiment, the conditioned pro-tolerogenic blood is obtained at least 2, 3, 4, 5, 6 or 7 days after the administration of the first leukocyte. In an embodiment, the conditioned pro-tolerogenic blood can be obtained by administering at least 5×10⁶ allogeneic polymer-modified leukocytes to the test subject (e.g. test mouse) and recuperating the plasma five days later. In some embodiments, the conditioned pro-tolerogenic blood can be obtained by administering at least 20×10⁶ allogeneic polymer-modified leukocytes to the test subject (e.g. test mouse).

As indicated herein, the two leukocyte populations are considered allogeneic (and in some embodiments, xenogeneic). When the acellular pro-tolerogenic preparation is obtained in vivo by, for example, a conditioned pro-tolerogenic blood/blood fraction can be obtained by administering the first leukocyte to the test subject, the first leukocyte can be allogeneic or xenogeneic to the test subject. In such embodiment, it is also contemplated that the first leukocyte be autologous, syngeneic, allogeneic or xenogeneic to a treated subject who is going to receive the acellular pro-tolerogenic preparation. When the acellular pro-tolerogenic preparation is obtained in vitro by, for example, a conditioned pro-tolerogenic medium can be obtained by co-culturing the first leukocyte with the second leukocyte, the first leukocyte can be allogeneic or xenogeneic to the second leukocyte. In such embodiment, it is also contemplated that the first leukocyte be autologous, syngeneic, allogeneic or xenogeneic to a treated subject who is going to receive the acellular pro-tolerogenic preparation. In addition, it is also contemplated that the second leukocyte be autologous, syngeneic, allogeneic or xenogeneic to a treated subject who is going to receive the acellular pro-tolerogenic preparation.

Once the conditioned pro-tolerogenic preparation (medium or blood for example), it can be further processed to substantially remove the cells and cellular debris that can be present. This processing step can be achieved by submitting the conditioned pro-tolerogenic medium or the conditioned pro-tolerogenic blood to a centrifugation step and/or a filtration step. For example, blood can be processed as to obtain the plasma. Since the majority of the immuno-modulatory effects of the acellular pro-tolerogenic preparations reside in a fraction sensitive to ribonucleic acid degradation (e.g., RNase degradation), this process step should be conducted in conditions which would substantially limit or even inhibit ribonucleic acid degradation.

The conditioned pro-tolerogenic preparation can also be processed (preferably after the removal of cells/cellular debris) so as to provide enrichment in at least one miRNA species, and preferably a plurality of miRNA species. As used in the context of this disclosure, the term “enrichment” refers to the step of increasing the concentration of one or more miRNA species in the acellular pro-tolerogenic preparation when compared to conditioned pro-tolerogenic medium/blood. In an embodiment, the term enrichment refers to the step of increasing, in the acellular pro-tolerogenic preparation, the concentration but not the relative abundance of the miRNA species present in the conditioned pro-tolerogenic medium/blood. In still another embodiment, the enrichment step can comprise substantially isolating the miRNA species from other components that may be present the conditioned pro-tolerogenic medium/blood (e.g., proteins such as cytokines for example). This enrichment step can be completed using various methods known to those skilled in the art, for example, chromatography, precipitation, etc. Since most of the immuno-modulatory effects of the acellular pro-tolerogenic preparations reside in a fraction sensitive to ribonucleic acid degradation (e.g., RNase degradation), this process step should be conducted in conditions which would substantially limit or even inhibit ribonucleic acid degradation.

The conditioned pro-tolerogenic preparation can also be processed to substantially remove the protein components (including the cytokines) and/or the deoxyribonucleic acid components that may be present. Such further purification step can be made, for example, by using proteinase (to provide a protein-free acellular pro-tolerogenic preparation), DNAse (to provide a DNA-free acellular pro-tolerogenic preparation), chromatography or filtration (to provide a fraction enriched in size-specific components present in the conditioned pro-tolerogenic medium/blood).

In some embodiments, it is also contemplated that the acellular pro-tolerogenic preparation be submitted to the selective enrichment in components of the conditioned medium/blood having a relative size equal to or lower than about 20 kDa, 19 kDa, 18 kDa, 17 kDa, 16 kDa, 15 kDa, 14 kDa, 13 kDa, 12 kDa, 11 kDa, 10 kDa, 9 kDa, 8 kDa, 7 kDa, 6 kDa, 5 kDa, 4 kDa or 3 kDa.

Once the acellular pro-tolerogenic preparation has been obtained, it can be formulated for administration to the subject. The formulation step can comprise admixing the acellular pro-tolerogenic preparations with pharmaceutically acceptable diluents, preservatives, solubilizers, emulsifiers, and/or carriers. The formulations are preferably in a liquid injectable form and can include diluents of various buffer content (e.g., Tris-HCl, acetate, phosphate), pH and ionic strength, additives such as albumin or gelatin to prevent absorption to surfaces. The formulations can comprise pharmaceutically acceptable solubilizing agents (e.g., glycerol, polyethylene glycerol), anti-oxidants (e.g., ascorbic acid, sodium metabisulfite), preservatives (e.g., thimerosal, benzyl alcohol, parabens), bulking substances or tonicity modifiers (e.g., lactose, mannitol). The formulation step can also comprise placing the acellular pro-tolerogenic preparation in a recipient (e.g., physically distinct) which will prevent direct contact with the acellular pro-inflammatory preparation.

In some embodiments, the acellular pro-tolerogenic preparations can be formulated for simultaneous or sequential use with other substances capable of favoring a state of immune tolerance, for example cortisone, IL-10, IL-11 and/or IL-12.

(ii) Process for Obtaining the Acellular Pro-inflammatory Preparation

The acellular pro-inflammatory preparations presented described herein can be obtained by contacting two distinct and allogeneic leukocyte populations (referred herein to the third leukocyte and the fourth leukocyte). The two leukocyte populations are contacted under conditions so as to allow (and in some embodiments to favor) pro-inflammatory allo-recognition and to prevent (and in some embodiments to inhibit) pro-tolerogenic allo-recognition.

In some embodiments, the third and fourth leukocytes are used in a unmodified form (e.g., they are not modified to bear on their surface a low-immunogenic polymer). In alternative embodiments, it is possible that the third and/or the fourth leukocyte be modified to bear on their surface a low-immunogenic polymer. In such embodiment, it is important that the polymer grafted or the conditions used to graft the polymer do not significantly alter the ability of the two leukocyte populations to mediate a pro-inflammatory allo-recognition. It is important that the polymer used exhibits both low-immunogenicity and biocompatibility once introduced into a cell culture system or administered to the test subject. Polyethylene glycol (particularly methoxypoly(ethylene glycol)), 2-alkyloxazoline (POZ) such as, for example, polyethyloxazoline (PEOZ) and hyperbranched polyglycerol (HPG) are exemplary polymers which all exhibit low immunogenicity and biocompatibility and can be successfully used to modify the third and/or fourth leukocyte. In some embodiments, it is preferable to use a single type of polymer to modify the surface of leukocytes. In other embodiments, it is possible to use at least two distinct types of polymers to modify the surface of the leukocyte.

In an embodiment, the low-immunogenic biocompatible polymer can be covalently associated with the membrane-associated protein(s) of the leukocyte by creating a reactive site on the polymer (for example by deprotecting a chemical group) and contacting the polymer with the leukocyte. For example, for covalently binding a methoxypoly(ethylene glycol) to the surface of a leukocyte, it is possible to incubate a methoxypoly(-ethylene glycol) succinimidyl valerate (reactive polymer) in the presence of the leukocyte. The contact between the reactive polymer and the leukocyte is performed under conditions sufficient for providing a grafting density which will allow pro-inflammatory allo-recognition and prevent pro-tolerogenic allo-recognition. In an embodiment, the polymer is grafted to a viable leukocyte and under conditions which will retain the viability of the leukocyte. A linker, positioned between the surface of the leukocyte and the polymer, can optionally be used. Examples of such polymers and linkers are described in U.S. Pat. Nos. 5,908,624; 8,007,784 and 8,067,151. In another embodiment, the low-immunogenic biocompatible polymer can be integrated within the lipid bilayer of the cytoplasmic membrane of the leukocyte by using a lipid-modified polymer.

As indicated above, it is important that the low-immunogenic biocompatible polymer be grafted at a density sufficient allowing pro-inflammatory allo-recognition while preventing pro-tolerogenic allo-recognition of the third leukocyte by the fourth leukocyte (and vice versa). In an embodiment, the polymer is polyethylene glycol (e.g., linear) and has an average molecular weight between 2 and 40 KDa as well as any combinations of molecular weight within this range. In another embodiment, the polymer is polyethylene glycol (e.g. linear) and has an average molecular weight between 2 and 40 KDa as well as any combinations of molecular weight within this range. In a further embodiment, the average molecular weight of the PEG to be grafted is at least 2, 3, 4, 5, 10, 15, 20, 25, 30, 35 or 40 kDa. In another embodiment, the average molecular weight of the PEG to be granted is no more than 40, 35, 30, 25, 20, 15, 10, 5, 4, 3, or 2 kDa. In another embodiment, the grafting concentration of the polymer (per 20×10⁶ cells) is no more than 2.4, 2.0, 1.0, 0.5, 0.4, 0.3, 0.2, 0.1, 0.05, 0.01 or 0.005 mM. In still another embodiment, the grafting concentration of the polymer (per 20×10⁶ cells) is equal to or lower than 0.005, 0.01, 0.05, 0.1, 0.2, 0.3, 0.4, 0.5, 1.0, 2.0, 2.4 mM. In embodiments where the polymer is grafter to affect the viability of the leukocyte (for example by creating cellular instability, cellular fragmentation or vesiculization, the concentration of the polymer (per 20×10⁶ cells) is equal to or higher than 10 mM. In order to determine if pro-inflammatory allo-recognition occurs, various techniques are known to those skilled in the art and include, but are not limited to, a standard mixed lymphocyte reaction (MLR), high molecular weight mitogen stimulation (e.g. PHA stimulation) as well as flow cytometry (Chen and Scott, 2006). In order to determine if a pro-tolerogenic allo-recognition occurs, various techniques are known to those skilled in the art and include, but are not limited to, the assessment of the level of expansion and differentiation of Treg cells and or prevention of Th17 expansion/differentiation.

The third leukocyte can be optionally modified to refrain from being proliferative. This modification preferably occurs prior to its introduction in a cell culture system or its administration into a test subject. For example, the leukocyte can be irradiated (e.g. γ-irradiation) prior to its introduction in a cell culture system or in the test subject. Upon irradiation, the leukocyte is not considered viable (e.g. capable of proliferation). In an embodiment, polymer grafting can affect the leukocyte viability and be used to refrain the leukocyte from proliferating. Alternatively, leukocyte can be treated with a pharmacological agent capable of halting cell cycle progression. Upon the administration of such pharmacological agent, the leukocyte is considered viable since it can resume cellular proliferation when the agent is removed from the cell-containing medium.

It is also contemplated that the fourth leukocyte (which can optionally be modified with the low-immunogenic and biocompatible polymer) be also optionally modified to refrain from being proliferative. For example, the leukocyte can be irradiated (e.g. γ-irradiation) prior to its introduction in a cell culture system or in the test subject. Upon irradiation, the leukocyte is not considered viable (e.g. capable of proliferation). In an embodiment, polymer grafting can affect the leukocyte viability and can be used to refrain the leukocyte from proliferating. Alternatively, leukocyte can be treated with a pharmacological agent capable of halting cell cycle progression. Upon the administration of such pharmacological agent, the leukocyte is considered viable since it can resume cellular proliferation when the agent is removed from the cell-containing medium. However, when the fourth leukocyte is modified from being proliferative, it is important the third leukocyte with which it is being contacted remains proliferative.

In order to generate the acellular pro-inflammatory preparations, it is not necessary to provide homogeneous leukocyte populations. For example, the third leukocyte population (such as, for example a PBMCs or splenocytes) can be introduced in a cell culture system and contacted with a fourth leukocyte population (such as, for example a PBMCs or splenocytes) or administered to the test subject. However, in some embodiments, it is possible to provide and contact more homogeneous leukocyte populations. For example, the third leukocyte population can be relatively homogenous (such as, for example, a T cell population) and introduced in a cell culture system comprising a fourth leukocyte population (such as, for example a PBMC or splenocyte) or administered to the test subject. In another example, the third leukocyte population (such as, for example a PBMC or splenocyte) can be introduced in a cell culture system comprising a fourth leukocyte population which can be relatively homogeneous (such as, for example, a T cell population). In a further example, the third leukocyte population can be relatively homogenous (such as, for example, a T cell population) and introduced in a cell culture system comprising a fourth leukocyte population which can be relatively homogeneous (such as, for example, a T cell population).

To provide the acellular pro-inflammatory preparations described herewith, the leukocytes used can be mature leukocytes or be provided in the form of stem cells (e.g., for example non-embryonic stem cells). For example, leukocytes can be obtained from isolating peripheral blood mononuclear cells (PBMC) from the subject. Optionally, the PBMCs can be differentiated in vitro into dendritic (DC) or DC-like cells. Alternatively, the leukocytes can be obtained from the spleen (e.g. splenocytes). Leukocytes usually include T cells, B cells and antigen presenting cells. In some embodiments, cells of sufficient antigenic variation and immunogenicity are used. In addition, for providing the acellular pro-inflammatory preparations, the leukocytes but not erythrocytes are necessary since the polymer-modified erythrocytes are not capable of eliciting a pro-inflammatory allo-recognition when administered in a test subject. However, traces of erythrocytes in the leukocyte population used are tolerated (for example, less than about 10%, less than about 5% or less than about 1% of the total number of cells in the preparation).

Even though it is not necessary to further purify the leukocytes to provide the acellular pro-inflammatory preparations, it is possible to use a pure cell population or a relatively homogenous population of cells as leukocytes. This “pure” cell population and “relative homogenous population” of cells can, for example, essentially consist essentially of a single cell type of T cells, B cells, antigen presenting cells (APC) or stem cells. Alternatively, the population of cells can consist essentially of more than one cell type. The population of cells can be obtained through conventional methods (for example cell sorting or magnetic beads). In an embodiment, when the population of cells consist of a single cell type (for example, T cells), the percentage of the cell type with respect to the total population of cells is at least 90%, at least 95% or at least 99%. The relatively homogenous population of cells is expected to contain some contaminating cells, for example less than 10%, less than 5% or less than 1% of the total population of cells.

The third leukocyte and/or fourth leukocyte can be obtained from any animals, but are preferably derived from mammals (such as, for example, humans and mice). In an embodiment, the third or fourth leukocyte can be obtained from a subject intended to be treated with the acellular pro-inflammatory preparation.

The third and/or fourth leukocyte can be expanded in vitro prior to the introduction in a cell culture system or the administration to a test subject.

As indicated above, the third and fourth leukocyte are contacted under conditions to allow pro-inflammatory allo-recognition (e.g. expansion of pro-inflammatory T cells and/or differentiation of naïve T cells in pro-inflammatory T cells) and prevent/inhibit pro-tolerogenic allo-recognition (e.g. expansion of Treg cells and/or differentiation of naïve T cells in Treg cells). When the contact occurs in vitro, it is important that the third leukocyte and the fourth leukocyte be cultured under conditions allowing physical contact between the two leukocyte populations and for a time sufficient to provide a conditioned pro-inflammatory medium. As used herein, a conditioned pro-inflammatory medium refers to physical components of a cell culture (or fraction thereof, such as the cell culture supernatant) obtained by contacting the third and the fourth leukocyte and having the pro-inflammatory properties described herein. Usually, the conditioned medium is obtained at least 24 hours after the initial contact between the third and fourth leukocyte. In some embodiment, the conditioned medium is obtained at least 48 hours or at least 72 hours after the initial contact between the third and the fourth leukocyte. In an embodiment, the conditioned medium can be obtained after at least 24 hours of incubating a third leukocyte with a fourth leukocyte. When the incubation takes place in a 24-well plate, the concentration of each leukocyte population can be, for example, at least 1×10⁶ cells.

When the contact occurs in vivo, it is important that the third leukocyte be administered to an immune competent test subject (bearing the fourth leukocyte) and that the blood or blood fraction be obtained at a later a time sufficient to provide a conditioned pro-inflammatory blood. The test subject is a subject being immune competent and having a Treg/pro-inflammatory ratio which is substantially similar to age- and sex-matched healthy subjects. As used herein, the conditioned pro-inflammatory blood refers to physical components present in the blood (or fraction thereof, such as the plasma) obtained by administering the third leukocyte to the immune competent test subject and having the pro-inflammatory properties described herein. It is recognized by those skilled in the art that the conditioned pro-inflammatory blood may be obtained more rapidly by increasing the amount of leukocytes being administered or administering more than once (for example one, twice or thrice) the third leukocyte. Usually, the conditioned pro-inflammatory blood can be obtained at least one day after the administration of the third leukocyte. In some embodiment, the conditioned pro-inflammatory blood is obtained at least 2, 3, 4, 5, 6 or 7 days after the administration of the third leukocyte. In an embodiment, the conditioned pro-inflammatory blood can be obtained by administering at least 5×10⁶ allogeneic leukocytes to the test subject (e.g., test mouse) and recuperating the plasma five days later. In some embodiments, the conditioned pro-inflammatory blood can be obtained by administering at least 20×10⁶ allogeneic leukocytes to the test subject (e.g., test mouse).

In an embodiment, in order to obtain the conditioned pro-inflammatory blood, the test subject is transfused in conditions so as to allow a pro-inflammatory allo-recognition but to prevent the onset of GVHD. The third leukocyte is considered immunogenic (e.g. allogeneic) with respect to the test subject because when the third leukocyte is transfused into the animal, an immune response (e.g. a cell-mediated immune response, preferably a pro-inflammatory allo-recognition) occurs. In another embodiment, the third leukocyte can be xenogeneic with respect to the test subject. However, the third leukocyte cannot be autologous or syngeneic to the animal. In some embodiments, the third leukocyte can be allogeneic or xenogeneic to the subject which will be treated with the conditioned pro-inflammatory blood. In alternative embodiment, the third leukocyte can be syngeneic or derived from the subject which will be treated with the conditioned pro-inflammatory blood. In an embodiment, the third allogeneic leukocyte can be modified to bear on its surface a polymer. However, as indicated above, the polymer, when present, must be selected or grafted at a density so as to allow the pro-inflammatory allo-recognition of the first leukocyte by the recipient. When the third leukocyte is modified to bear on its surface a polymer, it can be modified to be non-proliferative either prior to or after the polymer modification.

As indicated herein, the two leukocyte populations are considered allogeneic (and in some embodiments, xenogeneic). When the acellular pro-inflammatory preparation is obtained in vivo by, for example, a conditioned blood/blood fraction can be obtained by administering the third leukocyte to the test subject, the third leukocyte can be allogeneic or xenogeneic to the test subject. In such embodiment, it is also contemplated that the third leukocyte be autologous, syngeneic, allogeneic or xenogeneic to a treated subject who is going to receive the acellular pro-inflammatory preparation. When the acellular pro-inflammatory preparation is obtained in vitro by, for example, a conditioned medium can be obtained by co-culturing the third leukocyte with the fourth leukocyte, the third leukocyte can be allogeneic or xenogeneic to the fourth leukocyte. In such embodiment, it is also contemplated that the third leukocyte be autologous, syngeneic, allogeneic or xenogeneic to a treated subject who is going to receive the acellular pro-inflammatory preparation. In addition, it is also contemplated that the fourth leukocyte be autologous, syngeneic, allogeneic or xenogeneic to a treated subject who is going to receive the acellular pro-inflammatory preparation.

Once the conditioned pro-inflammatory preparation has been obtained, it can be further processed to substantially remove the cells and cellular debris that can be present. This processing step can be achieved by submitting the conditioned pro-inflammatory medium or the conditioned pro-inflammatory blood to a centrifugation step and/or a filtration step. For example, blood can be processed as to obtain the plasma. Since the majority of the immuno-modulatory effects of the acellular pro-inflammatory preparations reside in a fraction sensitive to ribonucleic acid degradation (e.g., RNase degradation), this process step should be conducted in conditions which would substantially limit or even inhibit ribonucleic acid degradation.

The conditioned pro-inflammatory preparation can also be processed (preferably after the removal of cells/cellular debris) so as to provide enrichment in at least one miRNA species, and preferably a plurality of miRNA species. As used in the context of this disclosure, the term “enrichment” refers to the step of increasing the concentration of one or more miRNA species in the acellular pro-inflammatory preparation when compared to conditioned medium/blood. In an embodiment, the term enrichment refers to the step of increasing, in the acellular pro-inflammatory preparation, the concentration but not the relative abundance of the miRNA species present in the conditioned pro-inflammatory medium/blood. In still another embodiment, the enrichment step can comprise substantially isolating the miRNA species from other components that may be present the conditioned pro-inflammatory medium/blood (e.g., proteins such as cytokines for example). This enrichment step can be completed using various methods known to those skilled in the art, for example, chromatography, precipitation, etc. Since most of the immuno-modulatory effects of the acellular pro-inflammatory preparations reside in a fraction sensitive to ribonucleic acid degradation (e.g. RNase degradation), this process step should be conducted in conditions which would substantially limit or even inhibit ribonucleic acid degradation.

The conditioned pro-inflammatory preparation can also be processed to substantially remove the protein components (including the cytokines) and/or the deoxyribonucleic acid components that may be present. Such further purification step can be made, for example, by using proteinase (to provide a protein-free acellular pro-inflammatory preparation), DNAse (to provide a DNA-free acellular pro-inflammatory preparation), chromatography or filtration (to provide a fraction enriched in size-specific components present in the conditioned pro-inflammatory medium/blood).

In some embodiments, it is also contemplated that the acellular pro-inflammatory preparation be submitted to the selective enrichment in components of the conditioned medium/blood having a relative size equal to or lower than about 20 kDa, 19 kDa, 18 kDa, 17 kDa, 16 kDa, 15 kDa, 14 kDa, 13 kDa, 12 kDa, 11 kDa, 10 kDa, 9 kDa, 8 kDa, 7 kDa, 6 kDa, 5 kDa, 4 kDa or 3 kDa.

Once the acellular pro-inflammatory preparation has been obtained, it can be formulated for administration to the subject. The formulation step can comprise admixing the acellular pro-inflammatory preparation with pharmaceutically acceptable diluents, preservatives, solubilizers, emulsifiers, and/or carriers. The formulations are preferably in a liquid injectable form and can include diluents of various buffer content (e.g., Tris-HCl, acetate, phosphate), pH and ionic strength, additives such as albumin or gelatin to prevent absorption to surfaces. The formulations can comprise pharmaceutically acceptable solubilizing agents (e.g., glycerol, polyethylene glycerol), anti-oxidants (e.g., ascorbic acid, sodium metabisulfite), preservatives (e.g., thimerosal, benzyl alcohol, parabens), bulking substances or tonicity modifiers (e.g., lactose, mannitol). The formulation step can also comprise placing the acellular pro-inflammatory preparation in a recipient (e.g., physically distinct) which will prevent direct contact with the acellular pro-tolerogenic preparation.

In addition, if the acellular pro-inflammatory preparation is destined to be used to prevent, treat or alleviate the symptoms of cancer, it can be formulated to be co-administered with an anti-neoplastic agent. The acellular pro-inflammatory preparation can be formulated for simultaneous administration with the anti-neoplastic agent by admixing the anti-neoplastic agent with the acellular pro-inflammatory preparation. Alternatively, the acellular pro-inflammatory preparation can be formulated for administration prior to or after the anti-neoplastic agent, for example in a formulation that is physically distinct from the anti-neoplastic agent.

In another embodiment, if the acellular pro-inflammatory preparation is destined to be used to prevent, treat or alleviate the symptoms of an infection, it can be formulated to be co-administered with an anti-infective agent (such as an anti-parasitic, antibacterial, anti-viral or anti-fungal agent). The acellular pro-inflammatory preparation can be formulated for simultaneous administration with the anti-infective agent by admixing the anti-infective agent with the acellular pro-inflammatory preparation. Alternatively, the acellular pro-inflammatory preparation can be formulated for administration prior to or after the anti-infective agent, for example in a formulation that is physically distinct from the anti-infective agent.

In still another embodiment, if the acellular pro-inflammatory preparation is destined to be used to allow a robust immune response to a vaccine, it can be formulated to be co-administered with the vaccine. The acellular pro-inflammatory preparation can be formulated for simultaneous administration with the vaccine by admixing the vaccine with the acellular pro-inflammatory preparation. Alternatively, the acellular pro-inflammatory preparation can be formulated for administration prior to or after the vaccine, for example in a formulation that is physically distinct from the vaccine.

In yet another embodiment, the acellular pro-inflammatory preparation can be formulated with other therapeutic agents capable of providing pro-inflammatory effects such as, for example IL-2, IL-4, TNF-α and/or INF-γ.

(iii) Characterization of the miRNA Fraction of the Acellular Preparations

As shown herein, the miRNA fraction of the acellular preparation is associated with the majority of the immunomodulatory effects of the conditioned medium/blood. As also shown herein, the immunomodulatory effects of the miRNA fraction of the acellular preparations are greatly reduced (and even abolished) when the components of the conditioned blood/medium having an average molecular weight lower than about 10 kDa are removed or upon treatment with a ribonucleic acid degradation agent (such as RNase A).

The acellular preparations described herein does comprise a plurality (also referred to a population) of distinct miRNA species whose relative abundance differs between a conditioned pro-tolerogenic medium obtained, for example, from a mPEG MLR (e.g. in which two allogeneic leukocyte populations are co-cultured under conditions so as to allow pro-tolerogenic allo-recognition), a conditioned pro-inflammatory medium obtained, for example, from a control MLR (e.g. in which the two allogeneic leukocyte populations are co-cultured under conditions so as to allow pro-inflammatory allo-recognition) or a control medium obtained, for example, from resting cells (e.g. a single type of cultured leukocyte population). The relative abundance of the miRNA population also differs between a conditioned pro-tolerogenic blood obtained from the administration of polymer-modified allogeneic cells in a test subject (in which a pro-tolerogenic allo-recognition occurred), a conditioned blood obtained from the administration of unmodified allogeneic cells to a test subject (in which a pro-inflammatory allo-recognition occurred) or a control blood obtained from naïve test subject or sham-treated subjects. This modulation in the relative abundance of the various miRNA species of the acellular preparation is believed to be tied to its immunomodulatory effects. The increased abundance of single miRNA species, unchanged abundance of single miRNA species and/or decreased abundance of single miRNA species are believed to contribute to the immunomodulatory effects of the acellular preparations. In an embodiment, in the acellular preparations, the relative pattern of expression of the miRNA species is conserved.

In an embodiment, the acellular (protolerogenic and/or pro-inflammatory) preparation comprises at least one miRNA species presented in FIG. 9. In another embodiment, the acellular preparation comprises any combination of at least 2, 3, 4, 5, 10, 15, 20, 25, 30, 30, 35, 40, 45, 50, 55, 60, 65, 70, 75 or 80 of the miRNA species presented in FIG. 9. In still another embodiment, the acellular preparation comprises all the miRNA species presented in FIG. 9. In yet another embodiment, the relative abundance of the miRNA species in the acellular preparation is similar to the relative abundance of the miRNA species show in FIG. 9. FIG. 9 provides the following miRNA species: hsa-let-7a-5p, hsa-let-7c, hsa-let-7d-5p, hsa-let-7e-5p, hsa-let-7g-5p, hsa-miR-103a-3p, hsa-miR-105-5p, hsa-miR-125a-5p, hsa-miR-125b-5p, hsa-miR-126-3p, hsa-miR-128, hsa-miR-130a-3p, hsa-miR-132-3p, hsa-miR-134, hsa-miR-135a-5p, hsa-miR-135b-5p, hsa-miR-138-5p, hsa-miR-142-3p, hsa-miR-142-5p, hsa-miR-143-3p, hsa-miR-145-5p, hsa-miR-146a-5p, hsa-miR-147a, hsa-miR-148a-3p, hsa-miR-149-5p, hsa-miR-150-5p, hsa-miR-152, hsa-miR-155-5p, hsa-miR-15a-5p, hsa-miR-15b-5p, hsa-miR-16-5p, hsa-miR-17-5p, hsa-miR-181a-5p, hsa-miR-182-5p, hsa-miR-183-5p, hsa-miR-184, hsa-miR-185-5p, hsa-miR-186-5p, hsa-miR-187-3p, hsa-miR-18a-5p, hsa-miR-18b-5p, hsa-miR-191-5p, hsa-miR-194-5p, hsa-miR-195-5p, hsa-miR-196a-5p, hsa-miR-19a-3p, hsa-miR-19b-3p, hsa-miR-200a-3p, hsa-miR-203a, hsa-miR-205-5p, hsa-miR-206, hsa-miR-20a-5p, hsa-miR-20b-5p, hsa-miR-21-5p, hsa-miR-210, hsa-miR-214-3p, hsa-miR-223-3p, hsa-miR-23b-3p, hsa-miR-26a-5p, hsa-miR-26b-5p, hsa-miR-27a-3p, hsa-miR-27b-3p, hsa-miR-298, hsa-miR-299-3p, hsa-miR-29b-3p, hsa-miR-29c-3p, hsa-miR-302a-3p, hsa-miR-30b-5p, hsa-miR-30c-5p, hsa-miR-30e-5p, hsa-miR-31-5p, hsa-miR-325, hsa-miR-335-5p, hsa-miR-34a-5p, hsa-miR-363-3p, hsa-miR-379-5p, hsa-miR-383, hsa-miR-409-3p, hsa-miR-451a, hsa-miR-493-3p, hsa-miR-574-3p, hsa-miR-9-5p, hsa-miR-98-5p and hsa-miR-99b-5p.

In another embodiment, the acellular (protolerogenic and/or pro-inflammatory) preparation comprises at least one miRNA species whose relative abundance is increased in the conditioned medium/blood obtained from using non-modified leukocytes (capable of allowing a pro-inflammatory allo-recognition) when compared to a conditioned medium/blood obtained from using polymer-modified leukocytes (capable of allowing a pro-tolerogenic allo-recognition) or resting cells/naïve blood. Such miRNA species are listed in Tables 1A to 1D. In an embodiment, the relative abundance of miRNA species in the acellular preparations is similar to the relative abundance of miRNA species listed in any one of Tables 1A to 1D.

TABLE 1A miRNA species in which the relative abundance in the conditioned medium of the control MLR is increased when compared to the miRNA species's conditioned medium from resting cells/naïve blood (as determined in FIG. 9). miRNA species identified with an * show a log₂ fold regulation change or a p ≤ 0.05 on a volcano plot. hsa-let-7c hsa-miR-105-5p hsa-miR-130a-3p hsa-miR-134 hsa-miR-135a-5p hsa-miR-135b-5p* hsa-miR-142-3p hsa-miR-142-5p hsa-miR-147a* hsa-miR-149-5p hsa-miR-155-5p* hsa-miR-15a-5p hsa-miR-181a-5p hsa-miR-183-5p* hsa-miR-187-3p hsa-miR-18a-5p hsa-miR-18b-5p hsa-miR-200a-3p hsa-miR-203a* hsa-miR-205-5p hsa-miR-206* hsa-miR-210 hsa-miR-214-3p* hsa-miR-299-3p hsa-miR-29b-3p hsa-miR-302a-3p* hsa-miR-31-5p hsa-miR-325* hsa-miR-363-3p* hsa-miR-383 hsa-miR-451a hsa-miR-493-3p hsa-miR-574-3p hsa-miR-9-5p*

In a further embodiment, the acellular (protolerogenic and/or pro-inflammatory) preparation comprises at least one miRNA species listed Table 1A. In still a further embodiment, the acellular (protolerogenic and/or pro-inflammatory) preparation comprises a combination of at least 2, 3, 4, 5, 10, 15, 20, 25, 30 or 33 of any one of the miRNA species listed in Table 1A. In yet a further embodiment, the acellular (protolerogenic and/or pro-inflammatory) preparation comprises all the miRNA species listed in Table 1A.

In an embodiment, the acellular (protolerogenic and/or pro-inflammatory) preparation comprises at least one (or any combination of) miRNA species listed in Table 1A and showing a log₂ fold regulation change or a p≤0.05 on a volcano plot (e.g., hsa-miR-135b-5p, hsa-miR-147a, hsa-miR-155-5p, hsa-miR-183-5p, hsa-miR-203a, hsa-miR-206, hsa-miR-214-3p, hsa-miR-302a-3p, hsa-miR-325, hsa-miR-363-3p, hsa-miR-9-5p).

TABLE 1B miRNA species in which the relative abundance in the conditioned medium of control MRL is increased when compared to the miRNA species's abundance in the conditioned medium of the mPEG MRL and is decreased when compared the miRNA species' abundance in the medium from resting cells/naïve blood (as determined in FIG. 9). miRNA species identified with an * show a log₂ fold regulation change or a p ≤ 0.05 on a volcano plot. hsa-miR-183-5p* hsa-miR-203a* hsa-miR-363-3p*

In a further embodiment, the acellular (protolerogenic and/or pro-inflammatory) preparation comprises at least one miRNA species listed Table 1B. In still a further embodiment, the acellular (protolerogenic and/or pro-inflammatory) preparation comprises a combination of at least 2 of any one of the miRNA species listed in Table 1B. In yet a further embodiment, the acellular (protolerogenic and/or pro-inflammatory) preparation comprises all the miRNA species listed in Table 1B.

TABLE 1C miRNA species in which the relative abundance in the conditioned medium of the control MLR is increased when compared to miRNA species' abundance in the conditioned medium of the resting cells/naïve blood. The relative abundance of these miRNA species is also increased in the conditioned medium of the mPEG MLR when compared to miRNA species' abundance in the conditioned medium of the resting cells/naïve blood (as determined in FIG. 9). miRNA species identified with an * show a log₂ fold regulation change or a p ≤ 0.05 on a volcano plot. hsa-let-7c hsa-miR-105-5p hsa-miR-130a-3p hsa-miR-134 hsa-miR-135a-5p hsa-miR-135b-5p* hsa-miR-142-3p hsa-miR-142-5p hsa-miR-147a* hsa-miR-149-5p* hsa-miR-155-5p* hsa-miR-15a-5p hsa-miR-181a-5p hsa-miR-187-3p hsa-miR-18a-5p hsa-miR-18b-5p hsa-miR-200a-3p hsa-miR-205-5p hsa-miR-206* hsa-miR-210 hsa-miR-214-3p* hsa-miR-299-3p hsa-miR-29b-3p hsa-miR-302a-3p* hsa-miR-31-5p hsa-miR-383 hsa-miR-451a hsa-miR-493-3p hsa-miR-574-3p hsa-miR-9-5p*

In a further embodiment, the acellular (protolerogenic and/or pro-inflammatory) preparation comprises at least one miRNA species listed Table 1C. In still a further embodiment, the acellular (protolerogenic and/or pro-inflammatory) preparation comprises a combination of at least 2, 3, 4, 5, 10, 15, 20, 25 or 30 of any one of miRNA species listed in Table 1C. In yet a further embodiment, the acellular (protolerogenic and/or pro-inflammatory) preparation comprises all the miRNA species listed in Table 1C.

In an embodiment, the acellular (protolerogenic and/or pro-inflammatory) preparation comprises at least one (or any combination of) miRNA species listed in Table 1C and showing a log₂ fold regulation change or a p≤0.05 on a volcano plot (e.g., hsa-miR-135b-5p, hsa-miR-147a, hsa-miR-149-5p, hsa-miR-155-5p, hsa-miR-206, hsa-miR-214-3p, hsa-miR-302a-3p and/or hsa-miR-9-5p). In an embodiment, the acellular (protolerogenic and/or pro-inflammatory) preparation comprises at least one of hsa-mir-147a and hsa-mir-9-5p.

TABLE 1D Selection of the miRNA species from Table 1C which show an increase of a log₂ fold regulation change or a p ≤ 0.05 on a volcano plot. hsa-miR-135b-5p hsa-miR-147a hsa-miR-149-5p hsa-miR-155-5p hsa-miR-183-5p hsa-miR-203a-5p hsa-miR-206 hsa-miR-214-3p hsa-miR-302a-3p hsa-miR-363-3p hsa-miR-9-5p

In a further embodiment, the acellular (protolerogenic and/or pro-inflammatory) preparation comprises at least one miRNA species listed Table 1D. In still a further embodiment, the acellular (protolerogenic and/or pro-inflammatory) preparation comprises a combination of at least 2, 3, 4, 5, 6 or 7 of any one of miRNA species listed in Table 1D. In yet a further embodiment, the acellular (protolerogenic and/or pro-inflammatory) preparation comprises all the miRNA species listed in Table 1D.

In another embodiment, the acellular (protolerogenic and/or pro-inflammatory) preparation comprises at least one miRNA species whose relative abundance is decreased when compared to a conditioned medium/blood obtained from using polymer-modified leukocytes (capable of allowing pro-tolerogenic allo-recognition) or the medium from resting cells/naïve blood. Such miRNA species are listed in Tables 2A to 2D. In another embodiment, the relative abundance of the miRNA species in the acellular preparations is similar to the relative abundance of the miRNA species presented in any one of Tables 2A to 2D.

TABLE 2A miRNA species in which the relative abundance in the conditioned medium of the control MLR is decreased when compared to the miRNA species's conditioned medium from resting cells/naïve blood (as determined in FIG. 9). miRNA species identified with an * show a log₂ fold regulation change or a p ≤ 0.05 on a volcano plot. hsa-let-7a-5p* Has-let-7d-5p hsa-let-7e-5p* hsa-let-7g-5p hsa-miR-103a-3p hsa-miR-125a-5p hsa-miR-125b-5p hsa-miR-126-3p hsa-miR-128 hsa-miR-132-3p* hsa-miR-138-5p hsa-miR-143-3p hsa-miR-145-5p hsa-miR-146a-5p hsa-miR-148a-3p hsa-miR-150-5p hsa-miR-152 hsa-miR-15b-5p hsa-miR-16-5p hsa-miR-17-5p hsa-miR-182-5p hsa-miR-184 hsa-miR-185-5p hsa-miR-186-5p has-miR-191-5p hsa-miR-194-5p hsa-miR-195-5p hsa-miR-196a-5p hsa-miR-19a-3p hsa-miR-19b-3p hsa-miR-20a-5p hsa-miR-20b-5p hsa-miR-21-5p* hsa-miR-223-3p hsa-miR-23b-3p hsa-miR-26a-5p hsa-miR-26b-5p hsa-miR-27a-3p* hsa-miR-27b-3p* hsa-miR-298* hsa-miR-29c-3p hsa-miR-30b-5p hsa-miR-30c-5p hsa-miR-30e-5p hsa-miR-335-5p hsa-miR-34a-5p* hsa-miR-379-5p hsa-miR-409-3p hsa-miR-98-5p hsa-miR-99b-5p

In a further embodiment, the acellular (protolerogenic and/or pro-inflammatory) preparation comprises at least one miRNA species listed Table 2A. In still a further embodiment, the acellular (protolerogenic and/or pro-inflammatory) preparation comprises a combination of at least 2, 3, 4, 5, 10, 15, 20, 25, 30, 35, 40, 45 or 46 of any one of miRNA species listed in Table 2A. In yet a further embodiment, the acellular (protolerogenic and/or pro-inflammatory) preparation comprises all the miRNA species listed in Table 2A.

In an embodiment, the acellular (protolerogenic and/or pro-inflammatory) preparation comprises at least one (or any combination of) miRNA species listed in Table 2A and showing a log₂ fold regulation change or a p≤0.05 on a volcano plot (e.g., hsa-let-7a-5p, hsa-let-7e-5p, hsa-miR-132-3p, hsa-miR-21-5p, hsa-miR-27a-3p, hsa-miR-27b-3p, hsa-miR-298, hsa-miR-34a-5p).

TABLE 2B miRNA species in which the relative abundance in the conditioned medium of control MRL is decreased when compared to the miRNA species' abundance in the conditioned medium of the mPEG MRL (as determined in FIG. 9). miRNA species identified with an * show a log₂ fold regulation change. hsa-let-7a-5p* hsa-let-7e-5p* hsa-miR-132-3p* hsa-miR-21-5p* hsa-miR-27a-3p* hsa-miR-27b-3p* hsa-miR-298* hsa-miR-34a-5p*

In a further embodiment, the acellular (protolerogenic and/or pro-inflammatory) preparation comprises at least one miRNA species listed Table 2B. In still a further embodiment, the acellular (protolerogenic and/or pro-inflammatory) preparation comprises a combination of at least 2, 3, 4, 5, 6 or 7 of any one of the miRNA species listed in Table 2B. In yet a further embodiment, the acellular (protolerogenic and/or pro-inflammatory) preparation comprises all the miRNA species listed in Table 2B.

TABLE 2C Selection of the miRNA species from Table 2B which show a log₂ fold regulation change or a p ≤ 0.05 on a volcano plot. hsa-let-7a-5p hsa-let-7e-5p hsa-miR-132-3p hsa-miR-21-5p hsa-miR-27a-3p hsa-miR-27b-3p hsa-miR-298 hsa-miR-34a-5p

In a further embodiment, the acellular (protolerogenic and/or pro-inflammatory) preparation comprises at least one miRNA species listed Table 2C. In still a further embodiment, the acellular (protolerogenic and/or pro-inflammatory) preparation comprises a combination of at least 2, 3, 4, 5, 6 or 7 any one of miRNA species listed in Table 2C. In yet a further embodiment, the acellular (protolerogenic and/or pro-inflammatory) preparation comprises all the miRNA species listed in Table 2C.

TABLE 2D miRNA species in which the relative abundance in the conditioned medium of control MRL and in the condition medium of the mPRG MLR is decreased when compared to the miRNA species' abundance in the conditioned medium from resting cells/naïve blood (as determined in FIG. 9). hsa-let-7d-5p hsa-let-7g-5p hsa-miR-103a-3p hsa-miR-125a-5p hsa-miR-125b-5p hsa-miR-126-3p hsa-miR-128 hsa-miR-138-5p hsa-miR-143-3p hsa-miR-145-5p hsa-miR-146a-5p hsa-miR-148a-3p hsa-miR-150-5p hsa-miR-152 hsa-miR-15b-5p hsa-miR-16-5p hsa-miR-17-5p hsa-miR-182-5p hsa-miR-184 hsa-miR-185-5p hsa-miR-186-5p hsa-miR-191-5p hsa-miR-194-5p hsa-miR-195-5p hsa-miR-196a-5p hsa-miR-19a-3p hsa-miR-19b-3p hsa-miR-20a-5p hsa-miR-20b-5p hsa-miR-223-3p hsa-miR-23b-3p hsa-miR-26a-5p hsa-miR-26b-5p hsa-miR-29c-3p hsa-miR-30b-5p hsa-miR-30c-5p hsa-miR-30e-5p hsa-miR-335-5p hsa-miR-379-5p hsa-miR-409-3p hsa-miR-98-5p hsa-miR-99b-5p

In a further embodiment, the acellular (protolerogenic and/or pro-inflammatory) preparation comprises at least one miRNA species listed Table 2D. In still a further embodiment, the acellular (protolerogenic and/or pro-inflammatory) preparation comprises a combination of at least 2, 3, 4, 5, 10, 15, 20, 25, 30, 35, 40 or 42 of any one of miRNA species listed in Table 2D. In yet a further embodiment, the acellular (protolerogenic and/or pro-inflammatory) preparation comprises all the miRNA species listed in Table 2D.

It is contemplated that the acellular (protolerogenic and/or pro-inflammatory) preparation comprises at least one (and in an embodiment any combination of) miRNAs species from any one of Tables 1A to 1D and at least one (and in an embodiment any combination of) miRNAs species from any one of Tables 2A to 2D.

In yet another embodiment, the acellular (protolerogenic and/or pro-inflammatory) preparation can comprise at least one of the miRNA species identified in the volcano plots of FIG. 8. In still another embodiment, the acellular (protolerogenic and/or pro-inflammatory) preparation comprises at least one (or any combination of) miRNA species presented on FIG. 8A which exhibits at least a log₂ fold modulation in abundance (e.g. miR-302a-3p, miR214-3p, miR-147a, miR206, miR 155-5p and/or miR-9-5p). In yet still another embodiment, the acellular (protolerogenic and/or pro-inflammatory) preparation comprises at least one (or any combination of) of miRNA species presented on FIG. 8A which exhibits at least p≤0.05 (e.g. miR214-3p, miR-147a, miR206, miR 155-5p and/or miR-9-5p). In yet another embodiment, the acellular (protolerogenic and/or pro-inflammatory) preparation comprises at least one (or any combination of) miRNA species presented on FIG. 8B which exhibits at least a log₂ fold modulation in abundance (e.g. miR-149-5p and/or miR-214-3p). In yet still another embodiment, the acellular (protolerogenic and/or pro-inflammatory) preparation comprises the miRNA species presented on FIG. 8B which exhibits at least p≤0.05 (e.g. miR-214-3p). In yet another embodiment, the acellular (protolerogenic and/or pro-inflammatory) preparation comprises at least one (or any combination of) miRNA species presented on FIG. 8C which exhibits at least a log₂ fold modulation in abundance (e.g. miR-147a, miR-183-5p, miR-9-5p and/or miR-155-5p). In yet still another embodiment, the acellular (protolerogenic and/or pro-inflammatory) preparation comprises at least one (or any combination of) miRNA species presented on FIG. 8C which exhibits at least p≤0.05 (e.g. miR-9-5p and/or miR-155-5p). In another embodiment, the miRNA species that are present in the acellular preparations have a relative abundance which is similar to those presented in any one of FIGS. 8A to 8C.

It is contemplated that the acellular (protolerogenic and/or pro-inflammatory) preparation comprises at least one (and in an embodiment any combination of) miRNAs species from any one of Tables 1A to 1D, at least one (and in an embodiment any combination of) miRNAs species from any one of Tables 2A to 2D and at least one (and in an embodiment any combination of) miRNA species identified in any one of the FIG. 8A to 8C.

Methods for Modulating the Treg/Pro-inflammatory T Cells Ratio

The present disclosure provides methods and associated therapeutic uses for modulating the ratio of the level of regulatory T cells with respect to the level of pro-inflammatory T cells during a period of time for an individual. In the present context, the term modulation refers to a sequential increase in the immune response (e.g., a reduction in the Tregs/pro-inflammatory T cell ratio) and decrease in the immune response (e.g., an increase in the Tregs/pro-inflammatory T cell ratio) of a subject. In the present context, the increase can precede the decrease or the decrease can precede the increase. This modulation in immune response is an intentional one since it is triggered/induced by the administration of an exogenous biological acellular preparation.

In a first embodiment, the method allows to modulation of the ratio of Treg to pro-inflammatory T cells in a subject having received a first therapeutic dose (or multiple doses) of an acellular pro-tolerogenic preparation. The method thus allows, in such subject, a decrease in the ratio of Treg to pro-inflammatory T cells which was previously intentionally increased (by the administration of one or more doses of the acellular pro-tolerogenic preparation). In order to achieve this reduction in the ratio of Treg to pro-inflammatory T cells, at least one dose (or multiple doses) of the acellular pro-inflammatory preparation is administered to the subject. Further modulation of the ratio can be achieved by administering sequentially and, optionally in an alternate fashion, additional therapeutic doses of the acellular pro-tolerogenic preparations and the acellular pro-inflammatory preparations. In some embodiments, it may be advantageous to determine, prior to the administration of the first or any therapeutic dose of the acellular pro-inflammatory preparation, if the subject is in need of decreasing its Tregs to pro-inflammatory T cells ratio. This can be done by actually characterizing T cell subpopulations in the subject intended to be treated, measuring such ratio (and comparing it to ratios associated with age- and sex-matched healthy subjects) and/or identifying a condition which would require immune stimulation (e.g., an infection or a vaccine for example). The method can also encompass a step of administering the first or additional therapeutic dose of acellular pro-tolerogenic preparation to the subject in need thereof. In some embodiments, the method can also encompass identifying if the subject is in need of increasing its Tregs to pro-inflammatory T cells ratio prior to the administration of the first or any therapeutic dose of the acellular pro-tolerogenic preparation. This can be done by actually characterizing T cell subpopulations in the subject intended to be treated, measuring such ratio (and comparing it to ratios associated with age- and sex-matched healthy subjects) and/or identifying a condition which would require immune tolerance (e.g., the presence of an auto-immune condition for example).

In a second embodiment, the method allows to modulation of the ratio of Treg to pro-inflammatory T cells in a subject having received a first (or multiple) therapeutic dose of an acellular pro-inflammatory preparation. The method thus allows, in such subject, an increase in the ratio of Treg to pro-inflammatory T cells which was previously intentionally decreased (by the administration of the acellular pro-inflammatory preparation). In order to achieve this increase in the ratio of Treg to pro-inflammatory T cells, at least one therapeutic amount of at least one acellular pro-tolerogenic is administered. Further modulation of the ratio can be achieved by administering sequentially and, optionally in an alternate fashion, additional therapeutic doses of the acellular pro-inflammatory preparations and the acellular pro-tolerogenic preparations. In some embodiments, in some embodiments, it may be advantageous to determine, prior to the administration of a first or any acellular pro-tolerogenic preparation, if the subject is in need of increasing its Tregs to pro-inflammatory T cells ratio. This can be done by actually measuring such ratio (and comparing it to ratios associated with age- and sex-matched healthy subjects) and/or identifying a condition which would require immune tolerance (e.g., the presence of an auto-immune condition, a cell or tissue transplant, a risk of developing GVHD for example). The method can also encompass administering a first or additional therapeutic doses of an acellular pro-inflammatory preparation to the subject. In some embodiments, it may be advantageous to determine, prior to the administration of the first or any therapeutic dose of the acellular pro-inflammatory preparation, if the subject is in need of decreasing its Tregs to pro-inflammatory T cells ratio. This can be done by actually measuring such ratio (and comparing it to ratios associated with age- and sex-matched healthy subjects) and/or identifying a condition which would require immune stimulation (e.g., an infection, cancer progression or a vaccine for example).

(iv) Therapeutic Applications Aimed at Decreasing the Treg to Pro-inflammatory T Cell Ratio

In the present disclosure, the ratio can be decreased either by lowering the level of regulatory T cells in the subject or increasing the level of pro-inflammatory T cells in the subject. Alternatively, the ratio can be decreased by lowering the level of regulatory T cells in the subject and increasing the level of pro-inflammatory T cells in the subject. When the Treg/pro-inflammatory T cells ratio is decreased in a subject, it is considered that a state of immune stimulation is induced or present in the subject. The induction of a state of immune stimulation in subjects experiencing an abnormally decreased immune state can be therapeutically beneficial for limiting the symptoms or pathology associated with the abnormally low immune reaction or an acquired state of anergy. In some embodiments, it is not necessary to induce a state of complete immune stimulation, a partial induction of immune stimulation can be beneficial to prevent, treat and/or alleviate the symptoms of a disorder associated with a pro-tolerogenic state (such as, for example, a proliferation-associated disorder or an infection).

As shown herein, the administration of the acellular pro-inflammatory preparations induces a state of immune stimulation in the treated subject. In some embodiments, the state of stimulation can persist long after the administration of the acellular preparations (as shown below, at least 270 days in mice). Consequently, the methods and acellular preparations described herein are useful for the treatment, prevention and/or alleviation of symptoms associated with conditions caused/exacerbated by a low or inappropriate immune response.

A state of immune stimulation can be considered therapeutically beneficial in subjects experiencing a repressed immune response (anergy or tolerance), such as for example those observed upon the induction and maintenance of a proliferation-associated disorder (such as cancer). Some of these conditions are associated with either a high level of Tregs and/or a low level of pro-inflammatory T cells (such as Th17 and/or Th1) when compared to sex- and aged-matched healthy subjects. Because it is shown herein that the acellular-based preparations are beneficial for decreasing the ratio Tregs/pro-inflammatory T cells, it is expected that administration of the acellular-based preparations to afflicted subjects will treat, prevent and/or alleviate symptoms associated with the proliferation-associated disorder.

A state of immune stimulation can also be considered therapeutically beneficial in subjects at risk of developing an abnormally repressed immune response, a state or anergy or a pro-tolerogenic state. Such abnormally repressed immune responses can be observed in subjects being afflicted by or susceptible to be afflicted by a proliferation-associated disorder such as cancer. In some embodiments, the acellular pro-inflammatory preparations are used for the treatment, prevention and/or alleviations of symptoms of non-blood cancer (e.g. solid cancers), such as, for example, carcinoma, melanoma, sarcoma, blastoma and germ-cell tumors. In this embodiment, the methods can be applied to prevent or limit the onset or maintenance of a repressed immune response. The acellular pro-tolerogenic preparations can be co-administered with the other therapeutics currently used to manage the proliferation-associated disorder.

The acellular-based preparation can be administered to any subjects in need thereof, including humans and animals.

Such abnormally repressed immune responses can be also observed in subjects being infected, especially by a parasite or a virus. In these conditions, the methods and acellular preparations can be applied to prevent or limit the onset or maintenance of a repressed immune response. The acellular-based preparation can be co-administered with the other therapeutics currently used to manage the infection.

In an embodiment, the state of abnormal repression of the immune system is not caused by an infection of the immune cells themselves (e.g. EBV or HIV for example). However, in other embodiments, in instances where an infection of the immune cells is afflicting the subject, it is possible to use acellular pro-inflammatory preparations described to treat or alleviate the symptoms of the viral infection. For example, a leukocyte from the subject (preferably a cytotoxic T cell which is specific to the infectious agent) can be co-cultured with the acellular pro-inflammatory preparations described herein. After the co-culture, the cultured leukocyte can be reintroduced in the infected subject to treat and/or alleviate the symptoms associated to the infection (a viral infection, for example, an EBV or HIV infection). In another example, the acellular pro-inflammatory preparations described herein can be administered to the infected individual to provide immune stimulation.

In the methods preparations described herein, it is contemplated that the acellular-based preparations be optionally administered with other therapeutic agents known to be useful for the treatment, prevention and/or alleviation of symptoms of conditions associated to a condition caused/exacerbated by a low or inappropriate immune response, such as, for example, IL-2, IL-4, TNF-α and/or INF-γ.

(v) Therapeutic Applications Aimed at Increase in Treg to Pro-inflammatory T Cell Ratio

In the present disclosure, the ratio can be increased either by increasing the level of regulatory T cells in the subject or decreasing the level of pro-inflammatory T cells in the subject. Alternatively, the ratio can be increased by increasing the level of regulatory T cells in the subject and decreasing the level of pro-inflammatory T cells in the subject. When the Treg/pro-inflammatory T cells ratio is increased in a subject, it is considered that a state of immune tolerance is induced or present in the subject. The induction of a state of immune tolerance in subjects experiencing an abnormally elevated immune state can be therapeutically beneficial for limiting the symptoms or pathology associated with a pathological pro-inflammatory state (such as, for example, an auto-immune disease or an excessive immune response). In some embodiments, it is not necessary to induce a state of complete immune tolerance (e.g., anergy), a partial induction of immune tolerance can be beneficial to prevent, treat and/or alleviate the symptoms of a disorder associated with a pathological pro-inflammatory state.

Auto-immunity arises consequent to an animal/individual's immune system recognizing their own tissues as “non-self”. Autoimmunity is largely a cell-mediated disease with T lymphocytes playing a central role in “self” recognition and are, in many cases, also the effector cells. The Non-Obese Diabetic (NOD) mouse is an inbred strain that exhibits the spontaneous development of a variety of autoimmune diseases including insulin dependent diabetes. It is considered to be an exemplary mouse model of autoimmunity in general. The murine autoimmune diabetes develops beginning around 10 to 15 weeks of age and has been extensively used to study the mechanisms underlying autoimmune-mediated diabetes, therapeutic interventions and the effect of viral enhancers on disease pathogenesis. Diabetes develops in NOD mice as a result of insulitis, a leukocytic infiltrate of the pancreatic islets. This can be exacerbated if mice are exposed to killed mycobacterium or other agents (Coxsackie virus for example). Multiple studies have established that the pathogenesis of diabetes in the NOD mouse is very similar to that observed in human type I diabetes (T1D) in that it is characterized by the breakdown of multiple tolerance pathways and development of severe insulitis of the islets prior to β-cell destruction. Moreover, T cells (including Th1, Th17 and Tregs) have been identified as key mediators of the autoimmune disease process though other cells (NK cells, B-cells, DC and macrophages) are also observed. Indeed, the NOD mouse model has translated into successful clinical human trials utilizing T-cell targeting therapies for treatment of many autoimmune diseases, including T1D. The loss of function arising from pro-inflammatory allo-recognition is exemplified by the destruction of the islets of Langerhans (insulin secreting β cells) in the pancreas of the NOD mice leading to the onset of Type 1 diabetes. In the context of type I diabetes, pro-tolerogenic allo-recognition is going to confer the protection and survival of the islets of Langerhans and the inhibition of diabetes in the treated subject.

A state of anergy or immune tolerance can be considered therapeutically beneficial in subjects experiencing (or at risk of experiencing) an abnormal immune response, such as for example an auto-immune disease. Individuals afflicted by auto-immune diseases have either low levels of Tregs and/or elevated levels of pro-inflammatory T cells (such as Th17 and/or Th1) when compared to age- and sex-matched healthy individuals. Such auto-immune diseases include, but are not limited to, type I diabetes, rheumatoid arthritis, multiple sclerosis, lupus, immune thrombocytopenia, experimental autoimmune encephalomyelitis, auto-immune uveitis, psoriasis inflammatory bowel disease, scleroderma and Crohn's disease. Because it is shown herein that the acellular preparations are beneficial for increasing the ratio Tregs/pro-inflammatory T cells, it is expected that administration of the acellular preparations to afflicted subjects will alleviate symptoms associated with the auto-immune disease and/or prevent disease severity.

A state of anergy or tolerance can also be considered therapeutically beneficial in subjects at risk of developing an abnormally elevated/excessive immune response. Such abnormally elevated immune response can be observed in subjects receiving a vaccine. For example, it has been shown that subjects receiving a respiratory syncytial virus (RSV) vaccine develop an excessive immune response. Because it is shown herein that the acellular preparations are beneficial for increasing the ratio Tregs/pro-inflammatory T cells, it is expected that administration of the acellular preparations to subject having received or intended to receive a vaccine will alleviate symptoms associated with the administration of the vaccine and/or prevent the development of an excessive immune response. In such embodiment, the acellular preparation can be administered (or formulated for administration) prior to the vaccine, simultaneously with the vaccine or after the administration of the vaccine. When used to prevent or limit excessive immune response to a vaccine, the acellular preparations can be manufactured from a conditioned medium. The conditioned medium can be obtained by co-culturing a first leukocyte, being allogeneic or xenogeneic to a second leukocyte, which can be allogeneic, xenogeneic, autologous or syngeneic to the subject to be vaccinated. The second leukocyte, much like the first leukocyte, can be allogeneic, xenogeneic, autologous or syngeneic to the subject to be vaccinated. When used to prevent or limit an excessive immune response to a vaccine, the acellular preparations can also be manufactured from a conditioned blood. The conditioned blood can be obtained by administered a first leukocyte, being allogeneic or xenogeneic to the test subject, which can be allogeneic, xenogeneic, autologous or syngeneic to the subject to be vaccinated.

Such abnormally elevated immune response can also be observed in subjects having received a transplant (cells or tissues). In these instances, the acellular preparations can be used to prevent or limit the elevated/excessive immune response (e.g. graft destruction or graft rejection). In an embodiment, the acellular preparation can be contacted with the cells/tissue to be transplanted prior to the transplantation (e.g. for example in a transplant medium or a preservation medium). When used to prevent or limit graft destruction or graft rejection, the acellular preparations can be manufactured from a conditioned medium. The conditioned medium can be obtained by co-culturing a first leukocyte, being allogeneic or xenogeneic to a second leukocyte, which can be allogeneic, xenogeneic, autologous or syngeneic to the subject to be treated. Alternatively, the first leukocyte is allogeneic, xenogeneic, autologous or syngeneic to the cells or tissue intended to be grafted. The second leukocyte, much like the first leukocyte, can be allogeneic, xenogeneic, autologous or syngeneic to the subject to be treated. Alternatively, the second leukocyte is allogeneic, xenogeneic, autologous or syngeneic to the cells or tissue intended to be grafted. When used to prevent or limit graft destruction or graft rejection, the acellular preparations can also be manufactured from a conditioned blood. The conditioned blood can be obtained by administering a first leukocyte, being allogeneic or xenogeneic to the test subject, which can be allogeneic, xenogeneic, autologous or syngeneic to the subject to be treated. Alternatively, the first leukocyte is allogeneic, xenogeneic, autologous or syngeneic to the cells or tissue intended to be grafted.

Alternatively or optionally, the acellular preparations can also be used to prevent or limit a graft-vs.-host disease (GVHD) in a subject having received or intended to receive transplanted immune cells or stem cells. In an embodiment, the acellular preparations can be contacted (e.g. cultured) with the cells intended to be grafted prior to transfusion in the subject (e.g. for example in a transplantation medium or preservation medium) to induce a state of anergy or tolerance in those cells. In another embodiment, the acellular preparations can be administered to the subject prior to the transfusion of immune/stem cells to induce a state of anergy or tolerance to prevent or limit GVHD. In still another embodiment, the acellular preparations can be administered simultaneously with the transfused immune/stem cells to prevent or limit GVHD. In yet another embodiment, the acellular preparations can be administered to a subject having been transfused with immune cells or stem cells either to alleviate the symptoms associated to GVHD (when the subject experiences such symptoms) or to prevent GVHD (when the subject is at risk of experiencing such symptoms).

For the treatment of GVHD, the conditioned medium can be obtained by co-culturing two allogeneic/xenogeneic leukocyte populations. In an embodiment, the first leukocyte population can be allogeneic, xenogeneic, syngeneic to or derived from the donor (of the immune or stem cells). In another embodiment, the first leukocyte population can be allogeneic, xenogeneic, syngeneic to or derived from the recipient (intended to receive the immune or stem cells). In still another embodiment, the second leukocyte population can be allogeneic, xenogeneic, syngeneic to or derived from the donor. In yet another embodiment, the second leukocyte population can be allogeneic, xenogeneic, syngeneic to or derived from the recipient. For the treatment of GVHD, the conditioned blood can be obtained by administering a first leukocyte allogeneic or xenogeneic to the test subject (e.g. and in an embodiment to the donor). In an embodiment, the first leukocyte population can be allogeneic, xenogeneic, syngeneic to or derived from the donor. In another embodiment, the first leukocyte population can be allogeneic, xenogeneic, syngeneic to or derived from the recipient. The acellular preparation can be administered (or formulated for administration) prior to the transplant, simultaneously with the transplant or after the transplant.

In the methods described herein, it is contemplated that the acellular pro-tolerogenic preparations be optionally administered with other therapeutic agents known to be useful for the treatment, prevention and/or alleviation of symptoms of conditions associated to an excessive/abnormal immune response, such as, for example, cortisone, IL-10, IL-11 and/or IL-12.

The present invention will be more readily understood by referring to the following examples which are given to illustrate the invention rather than to limit its scope.

EXAMPLE I—MATERIAL AND METHODS

Human PBMC and dendritic cell preparation. Human whole blood was collected in heparinized vacutainer blood collection tubes (BD, Franklin Lakes, N.J.) from healthy volunteer donors following informed consent. PBMC were isolated from diluted whole blood using FicollePaque PREMIUM™ (GE Healthcare Bio-Sciences Corp, Piscataway, N.J.) as per the product instructions. The PBMC layer was washed twice with 1× Hank's Balanced Salt Solution (HBSS; without CaCl₂ and MgSO₄; Invitrogen by Life Technologies, Carlsbad, Calif.) and resuspended in the appropriate media as needed for mixed lymphocyte reactions and flow cytometric analysis of Treg and Th17 phenotypes. Dendritic cells (DC) were prepared from isolated PBMC as described by O'Neill and Bhardwaj (O'Neill et al., 2005). Briefly, freshly isolated PBMC were overlaid on Petri dishes for 3 h in AIM V serum free culture medium (Invitrogen, Carlsbad, Calif.). Non-adherent cells were gently washed off the plate. The adherent cells (monocyte rich cells) were treated with IL-4 and GM-CSF (50 and 100 ng/mL respectively; R&D Systems, Minneapolis, Minn.) in AIM V medium. Cells were again treated with IL-4 and GM-CSF on days 2 and 5. On day 6, cells were centrifuged and resuspended in fresh media supplemented with DC maturation factors (TNF-α, IL-1β, IL-6; R&D Systems, Minneapolis, Minn.) and prostaglandin E2 (Sigma Aldrich, St. Louis, Mo.). The mature DC-like cells were harvested on day 7 and CD80, CD83, CD86 and HLA-DR expressions were determined to confirm DC maturation via flow cytometry (FACSCalibur™ Flow Cytometer, BD Biosciences, San Jose, Calif.).

Murine splenocyte and tissue harvesting. All murine studies were done in accordance with the Canadian Council of Animal Care and the University of British Columbia Animal Care Committee guidelines and were conducted within the Centre for Disease Modeling at the University of British Columbia. Murine donor cells used for the in vivo donation and in vitro studies were euthanized by CO₂. Three allogeneic strains of mice were utilized for syngeneic and allogeneic in vitro and in vivo challenge: Balb/c, H-2^(d); C57Bl/6, H-2^(b); and C3H, H-2^(k). Murine spleens, brachial lymph nodes, and peripheral blood were collected at the indicated days. Mouse spleens and brachial lymph nodes were dissected and placed into cold phosphate buffered saline (PBS; 1.9 mM NaH₂PO₄, 8.1 mM Na₂HPO₄, and 154 mM NaCl, pH 7.3) containing 0.2% bovine serum albumin (BSA; Sigma Aldrich, St. Louis, Mo.) and kept on ice until ready to process. Whole blood was collected in heparinized tubes via cardiac puncture. Murine donor splenocytes were prepared from freshly harvested syngeneic or allogeneic spleens via homogenization into a cell suspension in PBS (0.2% BSA) using the frosted end of two microscope slides. The resultant cell suspension was spun down at 500×g. The splenocyte pellet was resuspended in 1 mL of 1×BD Pharm LYSE™ lysing buffer (BD Biosciences, San Diego, Calif.) and incubated for 1 min at room temperature. Lymph node cells were harvested via tissue homogenization as described above, washed twice and resuspended in PBS (0.2% BSA) for flow cytometric analysis of Th17, Treg and murine haplotype. Recipient peripheral blood lymphocytes were prepared via lysis of the red cells (BD Pharm Lyse lysing buffer; BD Biosciences, San Diego, Calif.) at 1× concentration, followed by washing (1×) and resuspension in PBS (0.2% BSA) for flow analysis of Th17, Treg and murine haplotype.

mPEG modification (PEGylation) of PBMCs and splenocytes. Human PBMC and murine splenocytes were derivatized using methoxypoly(-ethylene glycol) succinimidyl valerate (mPEG-SVA; Laysan Bio Inc. Arab, Ala.) with a molecular weight of 5 or 20 kDa as previously described (Scott et al., 1997; Murad et al, 1999; Chen et al., 2003; Chen et al., 2006). Grafting concentrations ranged from 0 to 5.0 mM per 4×10⁶ cells/mL. Cells were incubated with the activated mPEG for 60 min at room temperature in isotonic alkaline phosphate buffer (50 mM K₂HPO₄ and 105 mM NaCl; pH 8.0), then washed twice with 25 mM HEPES/RPMI 1640 containing 0.01% human albumin. Human PBMC were resuspended in AIM V media at a final cell density of 2.0×10⁶ cells/mL for use in the MLR. Murine splenocytes used for in vivo studies were resuspended in sterile saline at a final cell density of 2.0×10⁸ cells/ml for i.v. injection. To determine if the simple presence of the mPEG polymer itself altered the immune response either in vitro and in vivo, additional studies were done with unactivated polymer incapable of covalent grafting to the cell surface. For these studies, allogeneic human (in vitro studies) or syngeneic and allogeneic murine splenocytes (in vivo studies) were treated with non-covalently bound mPEG (soluble mPEG) under the same reaction conditions described for the covalent grafting studies. For clarity, “soluble mPEG” refers to cells treated with non-covalently grafted polymer while “mPEG-modified” refers to treatment with activated polymer resulting in the covalent grafting of the mPEG to the cell membrane.

In vitro and in vivo cell proliferation. Cell proliferation (both in vitro and in vivo) was assessed via flow cytometry using the CELLTRACE™ CFSE (Carboxyfluorescein diacetate, succinimidyl ester) Cell Proliferation Kit (Invitrogen by Life Technologies e Molecular probes, Carlsbad, Calif.). Human and murine cells labeling was done according to the product insert at a final concentration of 2.5 mM CFSE per 2×10⁶ cells total. Donor and recipient cell proliferation was differentially determined by haplotype analysis. In some experiments, cell proliferation was measured by ³H-thymidine incorporation. In these experiments, donor splenocytes (5.12×10⁶ cells per well) were co-incubated in triplicate in 96-well plates at 37° C., 5% CO₂ for 3 days. On day 3, all wells were pulsed with ³H-thymidine and incubated for 24 h at 37° C., 5% CO₂. Cellular DNA was collected on filter mats using a Skatron cell harvester (Suffolk, U.K.) and cellular proliferation was measured by ³H-thymidine incorporation.

Mixed lymphocyte reaction (MLR)—control and conditioned media. The immunodulatory effects of the various preparations were assayed using a MLR (Murad et al, 1999; Chen et al., 2003; Chen et al., 2006; Wang et al., 2011). For the human MLRs, PBMC from two MHC-disparate human donors were labeled with CFSE. For mice MLR, splenocytes from two H-2-disparate mice (Balb/c and C57Bl/6) were labeled with CFSE. Each MLR reaction well contained a total of 1×10⁶ cells (single donor for resting or mitogen stimulation or equal numbers for disparate donors for MLR). Cells were plated in multiwell flat-bottom 24-well tissue culture plates (BD Biosciences, Discovery Labware, Bedford, Mass.). PBMC proliferation, cytokine secretion, as well as Treg and Th17 phenotyping was done. For flow cytometric analysis, the harvested cells were resuspended in PBS (0.1% BSA).

Immunophenotyping by flow cytometry. The T lymphocytes populations (double positive for CD3⁺ and CD4⁺) in both the in vitro and in vivo studies were measured by flow cytometry using fluorescently labeled CD3 and CD4 monoclonal antibodies (BD Pharmingen, San Diego, Calif.). Human and mouse Regulatory T lymphocytes (Treg) were CD3⁺/CD4⁺ and FoxP3⁺ (transcription factor) while inflammatory Th17 lymphocytes cells were CD3⁺/CD4⁺ and IL-17⁺ (cytokine) as measured per the BD Treg/Th17 Phenotyping Kit (BD Pharmingen, San Diego, Calif.). Additional cell surface markers were also used to characterize the cells or subsets of cells obtained: anti-CD69 (clone H1.2F3, BD Biosciences) and anti-CD25 (BD Biosciences). After the staining, the cells (1×10⁶ cells total) were washed and resuspended in PBS (0.1% BSA) prior to flow acquisition. Isotype controls were also used to determine background fluorescence. All samples were acquired using the FACSCalibur™ flow cytometer (BD Biosciences, San Jose, Calif.) and CellQuest Pro™ software for both acquisition and analysis.

Conditioned plasma. Mouse were either untreated (naïve) or treated with saline, non-polymer modified allogeneic splenocytes or PEGylated allogeneic splenocytes (obtained by the procedures explained above). After five days, a cell-free conditioned plasma was obtained (from mouse blood using the mirVana™ PARIS™ kit from Ambion by Life Technologies) and transfused to another naïve mouse.

Plasma fractionation. The plasma fractionation was performed using centrifugal filter molecular cutoff devices. Millipore's Amicon® Ultra-0.5 centrifugal filter devices were used (Amicon Ultra 3k, 10K, 30K, 50K, and 100K devices).

miRNA extraction. The miRNA was extracted from samples (conditioned medium or plasma) using mirVana™ PARIS™ kit from Ambion® by Life Technologies according to the manufacturer's instructions. Briefly, the sample is mixed with the 2× denaturing solution provided and subjected to acid-phenol:chloroform extraction. To isolate RNA that is highly enriched for small RNA species, 100% ethanol was added to bring the samples to 25% ethanol. When this lysate/ethanol mixture was passed through a glass-fiber filter, large RNAs are immobilized, and the small RNA species are collected in the filtrate. The ethanol concentration of the filtrate was then increased to 55%, and it was passed through a second glass-fiber filter where the small RNAs become immobilized. This RNA is washed a few times, and eluted in a low ionic strength solution. Using this approach, an RNA fraction highly enriched in RNA species <200 nt can be obtained. Note that the large RNA species (>200 nt) can be recovered from the first filter if necessary.

TA preparations. The murine miRNA preparations (e.g. TA1 preparations) used were extracted from the conditioned plasma obtained 5 days after mice have received mPEG allogeneic splenocytes. Extraction can occur at time points other than 5 days (e.g., 24 hours post administration) and yield similar results (data not shown). Five days was chosen as Treg levels achieved maximal levels at this point in the mice. The human miRNA preparations (e.g. TA2 preparations) used were extracted from the conditioned medium of an mPEG-MLR harvested 72 hours following the initiation of the mPEG-MLR. However, miRNA harvested from human PBMC mPEG-MLR at 24 hours also yields the desired immunomodulatory effects (data not shown). To calibrate, miRNA concentration can be quantitated via a Qubit® 2.0 Fluorometer (LifeTechnologies) and selected fluorescent dyes which emit a signal only when bound to specific target (i.e., miRNA) molecules.

IA preparations. The murine miRNA preparations (e.g. IA1 preparations) used were extracted from the conditioned plasma obtained 5 days after mice have received non-polymer modified allogeneic splenocytes. Extraction can occur at time points other than 5 days (e.g., 24 hours post administration) and yield similar results (data not shown). Five days was chosen as Th17 levels achieved maximal levels and Treg cells had reach their minimal level at this point in the mice. The human miRNA preparations (e.g. IA2 preparations) used were extracted from the conditioned medium of an mPEG-MLR harvested 72 hours following the initiation of the mPEG-MLR. However, miRNA harvested from human PBMC mPEG-MLR at 24 hours also yields the desired immunomodulatory effects (data not shown). To calibrate, miRNA concentration can be quantitated via a Qubit® 2.0 Fluorometer (LifeTechnologies) and selected fluorescent dyes which emit a signal only when bound to specific target (i.e., miRNA) molecules.

miRNA characterization. The miRNA of the conditioned medium were characterized by qPCR using the miScript miRNA™ PCR Array Human Immunopathology (Qiagen) for human conditioned medium and the Mouse Immunopathology miRNA PCR Array™ (Qiagen) for mouse conditioned plasma/media.

RNase treatment. Murine plasma was pooled and for each individual mouse. For each 500 μL of murine plasma (or the <10 kDa plasma fraction), 50 ng RNase (RNase A, 20 mg/mL stock, Life Technologies (In Vitrogen)) was added. Then samples were incubated for 10 minutes at 37° C. to degrade the nucleic acids. The control plasma (or <10 kDa fraction) without RNAase A treatment was incubated at 37° C. for 10 min. The RNase treated plasma (100 μl per mouse) was injected (i.v.) into mice (n=5). RNase A alone (10 ng/mouse) was used for the control mice to insure that the RNase A was not toxic and this trace amount of RNase did not have an in vivo immunomodulatory effects.

Phosphorylation of phosphokinases. Analyzing the phosphorylation state of kinases and their protein substrates allows for the characterization of the effects of conditioned plasma or media on how cells respond to allogeneic stimuli. The human phospho-kinase array (R&D Systems Inc.) is a rapid, sensitive tool to simultaneously detect the relative levels of phosphorylation of 43 kinase phosphorylation sites and 2 related total proteins. Each capture antibody was carefully selected using cell lysates prepared from cell lines known to express the target protein. Capture and control antibodies are spotted in duplicate on nitrocellulose membranes. Cell lysates are diluted and incubated overnight with the human phospho-kinase array. The array is washed to remove unbound proteins followed by incubation with a cocktail of biotinylated detection antibodies. Streptavidin-HRP and chemiluminescent detection reagents are applied and a signal is produced at each capture spot corresponding to the amount of phosphorylated protein bound.

Statistical analysis. Data analysis for flow analysis was conducted using SPSS™ (v12) statistical software (Statistical Products and Services Solutions, Chicago, Ill., USA). For significance, a minimum p value of <0.05 was used. For comparison of three or more means, a one-way analysis of variance (ANOVA) was performed. When significant differences were found, a post-hoc Tukey test was used for pair-wise comparison of means. When only two means were compared, student-t tests were performed.

In vivo murine studies. Three genetically different strains: Balb/c, H-2^(d); C57Bl/6, H-2^(b); and C3H, H-2^(k) (Chen et al., 2003; Chen et al., 2006). All mice (donors and recipients) were 9-11 weeks old. Donor splenocytes were prepared and CSFE labeled as described. control and mPEG-grafted (1 mM, 20 kDa SVAmPEG) syngeneic or allogeneic cells (20×10⁶ splenocytes) were transfused intravenously (i.v.) via the tail vein into recipient animals. BALB/c and C57BL/6 mice injected with sterile saline served as control animals. Animals were euthanized by CO₂ at predetermined intervals at which time blood, brachial lymph nodes and spleen were collected and processed for Th17/Treg phenotyping analysis and splenocyte proliferation studies by flow cytometry. Donor cell engraftment and proliferation were assessed via flow cytometry using murine haplotype (H-2K^(b) vs. H-2K^(d)) analysis. To determine the persistence of the immunomodulation, mice were re-challenged (2° challenge) 30 days after the initial transfer of allogeneic or mPEG allogeneic splenocytes with unmodified allogeneic cells. At 5 days post 2° challenge, Treg and Th17 phenotyping of murine splenocytes isolated from the spleen, lymph node and peripheral blood was again assessed via flow cytometry.

Statistical analysis. Data analysis was conducted using SPSS™ (v12) statistical software (Statistical Products and Services Solutions, Chicago, Ill., USA). For significance, a minimum p value of <0.05 was used. For comparison of three or more means, a one-way analysis of variance (ANOVA) was performed. When significant differences were found, a post-hoc Tukey test was used for pair-wise comparison of means. When only two means were compared, student-t tests were performed.

EXAMPLE II—CHARACTERIZATION OF CONDITIONED PLASMA OBTAINED FROM ADMINISTERING POLYMER-GRAFTED AND NON-POLYMER-GRAFTED LYMPHOCYTES

The material and methods used in this example are provided in Example I.

In a first series of experiment, several types of conditioned plasma were obtained. Briefly, the conditioned plasma was first obtained from Balb/c mice having received saline, 20×10⁶ allogeneic (C57BL/6) PEGylated splenocytes (using 1 mM 20 kDa PEG) or 20×10⁶ allogeneic (C57BL/6) unmodified splenocytes. The conditioned plasma was either left untreated (e.g. complete) or fractionated in function of the size of its components (>100 kDa, between 30 and 100 kDa, between 10 and 30 kDa or <10 kDa). The saline of the treated conditioned plasma was then transfused to naïve C57BL/6 mice. Five days after the administration, the animals were sacrificed, the spleen was obtained and the cells they contained was characterized. As shown on FIG. 1A, the <10 kDa fraction of the conditioned plasma from mouse having received unmodified allogeneic splenocytes retained the ability, when compared to complete unfractionated conditioned plasma, to increase Th17 levels in vivo. As shown on FIG. 1B, the <10 kDa fraction of the conditioned plasma from mouse having received unmodified allogeneic splenocytes retained the ability, when compared to complete unfractionated conditioned plasma, to decrease Treg levels in vivo. The immunodulatory effect of conditioned murine plasma seems to mostly reside in the lower molecular weight fraction (<10 kDa). This low molecular weight fraction does not include the majority of cytokines (usually encompassed in the 100-30 and the 30-10 kDa fractions) typically thought to mediate immunodulation of Tregs and pro-inflammatory leukocytes. However, the <10 kDa fraction is suspected to contain, among its components, microRNAs (miRNAs). To determine if the miRNAs in the conditioned plasma mediated the immunomodulatory effects observed with the conditioned plasma, mice were injected with untreated conditioned plasma or conditioned plasma that had been pre-treated with RNase A, an enzyme that degrades/destroys ribonucleic acids such as miRNAs. As noted in FIG. 1C, treatment with RNase A greatly reduced the immunomodulatory activity of the conditioned plasma, thereby confirming the ribonucleic acid nature of the size-fractionated conditioned plasma.

To determine the effects of acellular components obtained from administering polymer-grafted and non-polymer grafted (e.g., unmodified) allogeneic lymphocytes on the immune response, a second series of in vivo experiments was conducted. The conditioned plasma was first obtained from Balb/c mice having received saline, 20×10⁶ allogeneic (C57BL/6) PEGylated splenocytes (using 1 mM 20 kDa PEG) or 20×10⁶ allogeneic (C57BL/6) unmodified splenocytes. Saline or one of the conditioned plasma obtained was administered to Balb/c mice either once (at day 0) or thrice (at days 0, 2 and 4). Five days after the last administration, the animals were sacrificed, the spleen and the brachial lymph node were obtained and the cells they contained was characterized. More specifically, the percentage of Foxp3⁺, CD69⁺ or CD25⁺ cells (with respect to the total number of CD4⁺ recuperated) was determined. As shown in FIG. 2A, the number of CD25⁺ cells was reduced in animals having received the conditioned plasma obtained from administering unmodified allogeneic splenocytes (Plasma (Allo) bars on FIG. 2A). On the other hand, the number of CD25⁺ cells was elevated in animals having received the conditioned plasma obtained from administering PEGylated allogeneic splenocytes (Plasma (mPEG-Allo) bars on FIG. 2A). The population of CD25⁺ cells includes Foxp3⁺ as well as Foxp3⁻ Treg cells. These findings suggest that the conditioned plasma obtained from administering unmodified allogeneic splenocyte reduces Treg cell levels and induces a pro-inflammatory immune reaction. These findings also suggests that the conditioned plasma obtained from administering polymer-modified allogeneic splenocyte increases Treg cell levels and induces an anti-inflammatory immune reaction.

As shown in FIG. 2B, the number of CD69⁺CD25⁻ cells (e.g., non-Foxp3 Tregs) was reduced in animals having received the conditioned plasma obtained from administering unmodified allogeneic splenocytes (Plasma (Allo) bars on FIG. 2B) and increased in animals having received the conditioned plasma obtained from administering polymer-modified allogeneic splenocytes (Plasma (mPEG-Allo) bars on FIG. 2B). Non-Foxp3 Tregs are known to be elevated in tumor-bearing mouse models are believed to limit/prevent the tumor regression in these animals. These findings suggest that the conditioned plasma obtained from administering unmodified allogeneic splenocytes decreases the level of such Treg subset and may be beneficial in facilitating tumor regression in tumor-bearing animals. These findings also suggest that the conditioned plasma obtained from administering polymer-modified allogeneic splenocytes increases the level of such Treg subset and may be beneficial in establishing an immune tolerance.

FIG. 2C compiles the data presented in FIGS. 2A and 2B and shows the various Treg subsets (Foxp3+, CD25+ and CD69+ cells as a percentage of the total CD4+ cells) in the spleen and in the brachial lymph nodes of the treated animals.

The size-fractionation conditioned plasma was administered to mice and its effects on the intracellular cytokine expression of CD4⁺ cells were examined. As shown on FIG. 3A, the <10 kDa fraction and some of the <3 kDa fraction of the conditioned plasma from mouse having received unmodified allogeneic splenotytes do not modulate IL-10 intracellular expression in CD4⁺ cells in vivo, whereas the <10 kDa fraction and some of the <3 kDa fraction of the conditioned plasma from mouse having received polymer-modified allogeneic splenotytes do modulate IL-10 intracellular expression in CD4⁺ cells in vivo. In contrast, the <10 kDa fraction and the <3 kDa fraction of the conditioned plasma from mouse having received unmodified allogeneic splenocytes increased IL-2, TNF-α, IFN-γ and IL-4 intracellular expression in CD4⁺ cells in vivo, whereas the <10 kDa fraction and the <3 kDa fraction of the conditioned plasma from mouse having received unmodified allogeneic splenocytes increased IL-2, TNF-α, IFN-γ and IL-4 intracellular expression in CD4⁺ cells in vivo (FIGS. 3B to 3E). The <10 kDa (and some of the >3 kDa) fraction of the conditioned plasma derived from unmodified allogeneic splenocytes, when compared to the corresponding fractions of the conditioned plasma derived from mPEG allogeneic splenocytes, increased the expression of pro-inflammatory cytokines, such as IL-2, TNF-α, IFN-γ or IL-4. However, pro-tolerogenic cytokines in animals having received conditioned plasma derived from unmodified allogeneic splenocytes remained at levels seen in naïve animals.

EXAMPLE III—CHARACTERIZATION OF MIRNA PREPARATIONS OBTAINED WITH POLYMER-GRAFTED OR NON-POLYMER-GRAFTED LYMPHOCYTES

The material and methods used in this example are provided in Example I.

The conditioned plasma or the miRNA preparation (100 μL) obtained from the conditioned plasma (of mice having received saline, unmodified allogeneic splenocytes or polymer-modified allogeneic splenocytes) were administered intravenously to 7-8 week-old mice thrice (at days 0, 2 and 4). Cohorts (n=4) of mice were sacrificed at days 30, 60, 120, 180 and 270. Spleens were removed and CD4⁺ cells were stained for intracellular expression of IL-2, IL-4, IL-10, INF-γ and TNF-α. Splenic Treg and Th17 populations were also measured. As shown on FIGS. 4A-C, the administration of the conditioned plasma or the derived miRNA preparation (i.e., IA1 preparations) from mouse having received unmodified allogeneic splenocytes caused an increase in the expression of intracellular IL-2 and INF-γ in CD4⁺ cells. On the other hand, the administration of the conditioned plasma or the derived miRNA preparation from mouse having received mPEG-modified allogeneic splenocytes (i.e., TA1 preparation) caused an increase in the expression of intracellular IL-10 in CD4⁺ cells.

These modulations in expression were observed until at least 270 days after the administration of the conditioned medium or the miRNA preparation. This data suggests that miRNA was an active component mediating the immunological changes, RNase treatment of the conditioned plasma or of the miRNA preparation prior to administration to animals either diminished (plasma) or abolished (miRNA) the immunomodulatory effects. While conditioned plasma retained some immunomodulatory effect, it is believed that it was due to residual cytokines and/or plasma-mediated inactivation of the RNAase A enzyme.

As also shown on FIG. 4D, the administration of the conditioned plasma or the derived miRNA preparation from mouse having received unmodified allogeneic splenocytes (i.e., IA1 preparations) caused a decrease in the percentage of Treg (Foxp3⁺) cells in function of the total CD4⁺ cells, whereas the administration of the conditioned plasma or the derived miRNA preparation from mouse having received polymer-modified allogeneic splenocytes (i.e., TA1 preparations) caused an increase in the percentage of Treg (Foxp3⁺) cells in function of the total CD4⁺ cells. In addition, the administration of the conditioned plasma or the derived miRNA preparation (i.e., IA1 preparations) from mouse having received unmodified allogeneic splenocytes caused an increase in the percentage of Th17 (IL-17⁺) cells in function of the total CD4⁺ cells, whereas the administration of the conditioned plasma or the derived miRNA preparation (i.e., TA1 preparations) from mouse having received polymer-modified allogeneic splenocytes caused a decrease in the percentage of Th17 (IL-17⁺) cells in function of the total CD4⁺ cells (FIG. 4E). These modulations in CD4⁺ cells types were observed at least 270 days after the administration of the conditioned medium or the miRNA preparations and were diminished (plasma) or abolished (miRNA) with a preliminary RNase treatment. Acellular preparations prepared from mice injected with either allogeneic leukocytes exerted potent and long-lasting effects in naive recipient mice. In aggregate, unmodified allogeneic-derived preparations (plasma or miRNA) yielded a pro-inflammatory state while mPEG-allogeneic-derived preparations (plasma or miRNA) yielded a immunoquiescent state.

Murine (IA1 preparations) miRNA preparations exert a direct effect on cell signaling. Murine IA1 or TA1 preparations have been incubated with Jurkat cells (1×10⁶ cells/ml treated with 50 μl of IA1 or TA1/ml) and the level of phosphorylation of some of the phosphokinase has been measured after 30 minutes of incubation. As shown on FIG. 5, IA1 preparations favored the phosphorylation of the HSP60 and WNK1 kinases. As also shown on FIG. 5, TA1 preparations favored the phosphorylation of the Akt and PRAS40 while favoring the dephosphorylation of HSP60.

Murine IA1 preparations were also introduced (at time 0) into a human PBMC MLR assay in order to determine their effect on human allo-recognition. As indicated on FIG. 6, the presence of the murine IA1 preparations resulted in a dose-dependent increase in the percentage in leukocyte proliferation (at both 10 and 14 days) which is indicative of their pro-inflammatory effects. This data also indicates that the IA1 preparations show significant evolutionary conservations (both sequence specific and similarity) since the murine IA1 preparations are highly effective in a xenogeneic system (e.g. human MLR).

Murine TA1 preparations were also introduced (at time 0) into a human PBMC MLR assay in order to determine their effect on human allo-recognition. As indicated on FIG. 6, the presence of the murine TA1 preparations resulted in a dose-dependent decrease in the percentage in leukocyte proliferation (at both 10 and 14 days) which is indicative of their pro-tolerogenic effects. This data also indicates that the TA1 preparations show significant evolutionary conservations (both sequence specific and similarity) since the murine TA1 are highly effective in a xenogeneic system (e.g. human MLR).

Murine IA1 or TA1 preparations (100 μL) were administered once (at day 0) or thrice (at days 0, 2 and 4). Five days after the last administration, the mice were sacrificed, their spleen and brachial lymph nodes were obtained and the cells they contained were characterized. As described in PCT/CA2013/050963 filed on Dec. 13, 2013, IA1 preparations, unlike TA1 preparations, increased the percentage of NK cells (as measured by flow cytometry) with respect to the total number of CD4⁺ cells (data not shown). Similar results were obtained in the spleen and the lymph nodes (data not shown).

While the murine TA1 preparation proved effective both in vitro and in vivo in experimental models involving immunologically normal cells and animals, to test the effectiveness of the TA1 preparation, a model of autoimmune disease, NOD mice, were used. As described in PCT/CA2013/050545 filed on Jul. 12, 2013 and published under WO2014/008610 on Jan. 16, 2014, significant changes in the levels of Th17 and Treg lymphocytes are noted in the spleen, brachial lymph node and pancreatic lymph nodes upon conversion of NOD mice from non-diabetic to diabetic state (data not shown). These changes are characterized by dramatically increased Th17 (top numbers in each panels) and significantly decreased Treg (lower numbers in each panels) lymphocytes. Murine TA1 preparations were administered intravenously once to NOD mice. The administration of TA1 caused a shift in immune modulation at day 5 post treatment towards immune tolerance by decreasing the circulating blood levels of pro-inflammatory Th17 cells (data not shown). The administration of the murine TA1 preparations to NOD mice yielded significant protection against progression to diabetes (data not shown). The administration of the murine TA1 preparations to NOD mice caused a systemic and/or local increase in pro-tolerogenic leukocytes (data not shown). The administration of the murine TA1 preparations to NOD mice also caused a decrease in pro-inflammatory Th17 cells and Th1 cells as well as the decrease in the percentage of INF-γ⁺ cells, IL-2⁺ cells, TNF-α⁺ cells and IL-12⁺ cells (data not shown). This data suggest that the TA1 preparations prevented Th17/Th1 upregulation in the treated mice, and ultimately prevented islet cell destruction. Interestingly, the administration of TA1s caused a significant increase in the level of NK cells in the pancreas, but not in other tissues (data not shown). It is believed that the differentially induced NK cells in the pancreas destroys autoreactive (i.e. inflammatory) cells providing an additional immunomodulatory mechanism resulting in decreased diabetes. Further, it has been shown are that the administration of TA1s increased B10⁺ (B regulatory) cells and tolerogeneic DC cell levels while decreasing APC associated with inflammation (data not shown) further confirming the pro-tolerogenic effects of TA1s.

It was previously determined, for example in PCT/CA2013/050546 filed on Jul. 12, 2013 and published as WO2014/008611 on Jan. 16, 2014, that a shift to a pro-inflammatory state caused by the administration of non-polymer-modified cellular (lymphocyte) preparations was long lived as well as systemic and that animals did not revert back to their initial immunological state upon the administration of a polymer-modified cellular (lymphocyte) preparation. It was also previously determined, for example in PCT/CA2013/050546 filed on Jul. 12, 2013 and published as WO2014/008611 on Jan. 16, 2014, that a shift to a pro-tolerogenic state caused by the administration of polymer-modified cellular (lymphocyte) preparations was long lived as well as systemic and that animals did not revert back to their initial immunological state upon the administration of a unmodified cellular (lymphocyte) preparation. As such, it was thus determined if the acellular preparations described herein also induce a non-reversible long lived and systemic immune modulation.

In order to do so, the animals were divided into two groups: those receiving a single type of preparation and those receiving the two different types of preparations (sequentially administered). Saline, TA1 preparations (100 μL) or IA1 preparations (100 μL) were intravenously administered to naïve mice at days 0, 2 and 4. Animals receiving only a single type of preparations were then sacrificed at day 40. Animals receiving a second type of preparation were administered with IA1 preparations (how much) or TA1 preparations (how much) at days 9, 11 and 13 and were then sacrificed at day 40. Each treatment group contained at least 5 animals. The percentage of Treg (FIGS. 7A and 7B) and Th17 (FIGS. 7C and 7D) cells in the spleen and the brachial lymph nodes were then determined for the mice of the different treatment groups. As shown in FIGS. 7A to 7D, the administration of TA1 preparations (alone) caused an increase in Treg levels and a decrease in Th17 levels whereas, the administration of IA1 preparations (alone) caused a decrease in Treg levels and an increase in Th17 levels. It was surprisingly found that when animals previously administered TA1 preparations (which caused a shift towards a pro-tolerogenic state) were subsequently challenged with IA1 preparations, their Treg levels decreased and their Th17 ratio increased. On the other hand, when animals previously administered IA1 preparations (which caused a shift towards a pro-inflammatory state) were subsequently challenged with TA1 preparations, their Treg levels increased and their Th17 levels decreased. These results are surprising because, it was previously shown that a pro-tolerogenic state induced by the administration of polymer-modified allogeneic cellular preparations could not be shifted towards a more pro-inflammatory state upon the administration of a non-modified allogeneic cellular preparations (WO2014/008611). However, as shown herein, the secondary administration of IA1 was able to modulate the animals' immune response towards a more pro-inflammatory state once a pro-tolerogenic state has been induced. The results are also surprising because, it was previously shown that a pro-inflammatory state induced by the administration of non-modified allogeneic cellular preparations could not be shifted towards a more pro-tolerogenic state upon the administration of polymer-modified allogeneic preparations (WO2014/008611). However, as shown herein, the secondary administration of TA1 preparations was able to modulate the animals' immune response towards a more pro-tolerogenic state once a pro-inflammatory state has been induced.

EXAMPLE IV—miRNA CHARACTERIZATION OF ACELLULAR PROTOLEROGENIC PREPARATIONS

Some of the material and methods referred to in this example are provided in Example I.

In order to characterize the constituents of the miRNA preparations, the miRNA of conditioned medium collected at 72 hours from resting human PBMC, a human control MLR (using two HLA disparate PBMC populations), and a mPEG MLR (using the same two allogeneic PBMC populations wherein one population is modified with a polymer, e.g. mPEG) and compared via qPCR analysis. The miRNA preparations obtained from the human control MLR is referred to as IA2. The miRNA preparations obtained from the human mPEG MLR is referred to TA2. The combined average of the resting Donor A and resting Donor B (i.e., resting AB) were used, unless otherwise noted, for baseline in all analyses.

As shown in FIG. 8A, when the IA2 miRNA population is compared to the miRNA population of the supernatant of resting cells, using a volcano plot analysis, at least five different miRNAs are differentially expressed (e.g. increased) by statistical significance (p<0.01 for miR-9-5p, miR-155-5p, miR-206, miR-147a and p<0.05 for miR-214-3p) and at least one miRNA is modulated by at least a log₂ (e.g. miR-302a-3p).

In contrast, as shown in FIG. 8B, when the TA2 miRNA population is compared, using a volcano plot analysis, with the miRNA population of the supernatant of resting cells, at least one miRNA is differentially expressed (e.g. increased) by statistical significance (p<0.05 for miR-214-3p) and at least one miRNA is modulated by at least a log₂ fold (e.g. miR-149-5p).

A direct comparison of TA2 miRNA population to IA2 miRNA populations as shown in FIG. 8C, demonstrates that at least two miRNAs are differentially expressed by volcano statistical significance (p<0.01 for miR-155-5p and p<0.05 for miR-9-5p) and at least two miRNAs are modulated by at least a log₂ (e.g. miR-183-5p and mir-147a).

On FIG. 8C, nine miRNA species were identified. These miRNA species were selected because they were considered to be differentially expressed as determined by clustergram analysis between the AI2 and TA2 preparations. The miRNA species identified with 1, 2, 3, 5, 6, 8 and 9 showed increased abundance in the TA2 preparations relative to the IA2 preparations. The miRNA species identified with 4 has a relative abundance similar in both the IA2 preparation and TA2 preparations and elevated relative to resting cells.

Further characterization of the miRNA population of the IA2 preparations and the TA2 preparations is provided in fold change analysis. FIG. 9 provides a summary of the fold regulation of the purified miRNA preparations differentially expressed in the IA2 preparations and the TA2 preparations when compared to the conditioned medium of resting cells.

FIG. 10 provides a subset of the miRNAs presented in FIG. 9 and exhibiting at least a log₂ fold modulation when compared to resting cells. As indicated in FIG. 10, a subpopulation of miRNAs are decreased in the TA2 preparations and increased in the IA2 preparations (miR-183-5p, miR-203a, miR363-3p). As also indicated in FIG. 10, another subpopulation of miRNAs are increased in the TA2 preparation and decreased in the AI2 preparations (miR-21-5p, miR-27a-3p, miR 27b-3p, miR-298, miR-34a-5p, let-7a-5p, let-7e-5p, miR-132-3p).

REFERENCES

-   Chen A M, Scott M D. Immunocamouflage: prevention of     transfusion-induced graft-versus-host disease via polymer grafting     of donor cells. J Biomed Mater Res A 2003; 67:626-36. -   Chen A M, Scott M D. Comparative analysis of polymer and linker     chemistries on the efficacy of immunocamouflage of murine     leukocytes. Artif Cells Blood Substit Immobil Biotechnol 2006;     34:305-22. -   Murad K L, Gosselin E J, Eaton J W, Scott M D. Stealth cells:     prevention of major histocompatibility complex class II-mediated     T-cell activation by cell surface modification. Blood 1999;     94:2135-41. -   O'Neill D W, Bhardwaj N. Differentiation of peripheral blood     monocytes into dendritic cells. Curr Protoc Immunol; 2005. Chapter     22: Unit 22F.4.Kyluik-Price D. L., Li, L. and Scott, M. D.     Comparative Efficacy of Blood Cell Immunocamouflage by Membrane     Grafting of Methoxypoly(Ethylene Glycol) and Polyethyloxazoline.     Biomaterials 35(1):412-422 (2014). -   Scott M D, Murad K L, Koumpouras F, Talbot M, Eaton J W. Chemical     camouflage of antigenic determinants: stealth erythrocytes. Proc     Natl Acad Sci USA 1997; 94:7566-71. -   Wang D, Toyofuku W M, Chen A M, Scott M D. Induction of     immunotolerance via mPEG grafting to allogeneic leukocytes.     Biomaterials. 2011 December; 32(35):9494-503.

While the invention has been described in connection with specific embodiments thereof, it will be understood that it is capable of further modifications and this application is intended to cover any variations, uses, or adaptations of the invention following, in general, the principles of the invention and including such departures from the present disclosure as come within known or customary practice within the art to which the invention pertains and as may be applied to the essential features hereinbefore set forth, and as follows in the scope of the appended claims. 

What is claimed is:
 1. A therapeutic combination comprising at least one acellular pro-tolerogenic preparation and at least one acellular pro-inflammatory preparation for modulating the ratio of the level of regulatory T cells with respect to pro-inflammatory T cells in a subject, wherein: the at least one acellular pro-tolerogenic preparation comprises the following miRNA species: hsa-let-7a-5p, hsa-let-7e-5p, hsa-miR-21-5p, hsa-miR-27a-3p, hsa-miR-27b-3p, hsa-miR-34a-5p, hsa-miR-132-3p, hsa-miR-183-5p, hsa-miR-203a, hsa-miR-298 and hsa-miR-363-3p; the at least one acellular pro-inflammatory preparation comprises the following miRNA species: hsa-let-7a-5p, hsa-let-7e-5p, hsa-miR-9-5p, hsa-miR-21-5p, hsa-miR-27a-3p, hsa-miR-27b-3p, hsa-miR-34a-5p, hsa-miR-132-3p, hsa-miR-135b-5p, hsa-miR-147a, hsa-miR-149-5p, hsa-miR-155-5p, hsa-miR-183-5p, hsa-miR-203a, hsa-miR-203a-5p, hsa-miR-206, hsa-miR-214-3p, hsa-miR-298, hsa-miR-302a-3p and hsa-miR-363-3p; the at least one acellular pro-tolerogenic preparation and the at least one acellular pro-inflammatory preparation are adapted for a sequential administration to a subject; the at least one acellular pro-tolerogenic preparation is obtained by a first process comprising: (i) associating a low-immunogenic biocompatible polymer to a cytoplasmic membrane of a first leukocyte to obtain a first modified leukocyte, wherein the low-immunogenic biocompatible polymer is polyethylene glycol, hyperbranched polyglycerol or 2-alkyloxazoline; (ii) contacting the first modified leukocyte with a second leukocyte under conditions to allow a pro-tolerogenic allo-recognition to provide a pro-tolerogenic conditioned preparation, wherein the first modified leukocyte is allogeneic to the second leukocyte; (iii) removing components having an individual molecular weight of more than about 10 kDa from the pro-tolerogenic conditioned preparation under conditions to inhibit RNA degradation and maintain the relative abundance of the miRNA species so as to obtain a pro-tolerogenic composition enriched in acellular pro-tolerogenic components; and (iv) formulating the pro-tolerogenic composition of step (iii), under conditions to inhibit RNA degradation, in the acellular pro-tolerogenic preparation for administration to the subject; and the at least one pro-inflammatory preparation is obtained by a second process comprising: (a) contacting a third leukocyte with a fourth leukocyte under conditions to allow a pro-inflammatory allo-recognition to provide a pro-inflammatory conditioned preparation, wherein the third leukocyte is allogeneic to the fourth leukocyte; (b) removing components having an individual molecular weight of more than about 10 kDa from the pro-inflammatory conditioned preparation under conditions to inhibit RNA degradation and maintain the relative abundance of the miRNA species so as to obtain a pro-inflammatory composition enriched in acellular pro-inflammatory components; and (c) formulating the pro-inflammatory composition of step (b), under conditions to inhibit RNA degradation, in the acellular pro-inflammatory preparation for administration to the subject.
 2. The therapeutic combination of claim 1, wherein the acellular pro-tolerogenic preparation is adapted to be administered to the subject prior to the acellular pro-inflammatory preparation.
 3. The therapeutic combination of claim 2, further comprising a first and a second acellular pro-tolerogenic preparations, wherein the first acellular pro-tolerogenic preparation is adapted to be administered to the subject prior to the acellular pro-inflammatory preparation and wherein the second acellular pro-tolerogenic preparation is adapted to be administered to the subject after the acellular pro-inflammatory preparation.
 4. The therapeutic combination of claim 1, wherein the acellular pro-tolerogenic preparation is adapted to be administered to the subject after the acellular pro-inflammatory preparation.
 5. The therapeutic combination of claim 4, further comprising a first and a second acellular pro-inflammatory preparations, wherein the first acellular pro-inflammatory preparation is adapted to be administered to the subject prior to the acellular pro-tolerogenic preparation and wherein the second acellular pro-inflammatory preparation is adapted to be administered to the subject after the acellular pro-tolerogenic preparation.
 6. The therapeutic combination of claim 1, wherein the first process, at step (i), further comprises covalently binding the low-immunogenic biocompatible polymer to a membrane-associated protein of the cytoplasmic membrane of the first leukocyte.
 7. The therapeutic combination of claim 6, wherein the low-immunogenic biocompatible polymer is polyethylene glycol (PEG).
 8. The therapeutic combination of claim 1, wherein step (ii) of the first process or step (a) of the second process occurs in vitro.
 9. The therapeutic combination of claim 1, wherein step (ii) of the first process or step (a) of the second process occurs in vivo.
 10. The therapeutic combination of claim 1, wherein the first process, at step (iv) or the second process, at step (c), further comprises formulating the acellular composition for intravenous administration to the subject.
 11. The therapeutic combination of claim 1, wherein at least one of the first leukocyte, the second leukocyte, the third leukocyte or the fourth leukocyte is a T cell.
 12. The therapeutic combination of claim 1, wherein the acellular pro-tolerogenic preparation further comprises at least one miRNA species: hsa-let-7c, hsa-let-7d-5p, hsa-let-7g-5p, hsa-miR-15a-5p, hsa-miR-15b-5p, hsa-miR-16-5p, hsa-miR-17-5p, hsa-miR-18a-5p, hsa-miR-18b-5p, hsa-miR-19a-3p, hsa-miR-19b-3p, hsa-miR-20a-5p, hsa-miR-20b-5p, hsa-miR-23b-3p, hsa-miR-26a-5p, hsa-miR-26b-5p, hsa-miR-29b-3p, hsa-miR-29c-3p, hsa-miR-30b-5p, hsa-miR-30c-5p, hsa-miR-30e-5p, hsa-miR-31-5p, hsa-miR-98-5p, hsa-miR-99b-5p, hsa-miR-103a-3p, hsa-miR-105-5p, hsa-miR-125a-5p, hsa-miR-125b-5p, hsa-miR-126-3p, hsa-miR-128, hsa-miR-130a-3p, hsa-miR-134, hsa-miR-135a-5p, hsa-miR-138-5p, hsa-miR-142-3p, hsa-miR-142-5p, hsa-miR-143-3p, hsa-miR-145-5p, hsa-miR-146a-5p, hsa-miR-148a-3p, hsa-miR-150-5p, hsa-miR-152, hsa-miR-181a-5p, hsa-miR-182-5p, hsa-miR-184, hsa-miR-185-5p, hsa-miR-186-5p, hsa-miR-187-3p, has-miR-191-5p, hsa-miR-194-5p, hsa-miR-195-5p, hsa-miR-196a-5p, hsa-miR-200a-3p, hsa-miR-205-5p, hsa-miR-210, hsa-miR-223-3p, hsa-miR-299-3p, hsa-miR-335-5p, hsa-miR-379-5p, hsa-miR-383, hsa-miR-409-3p, hsa-miR-451a, hsa-miR-493-3p or hsa-miR-574-3p.
 13. The therapeutic combination of claim 1, wherein the acellular pro-inflammatory preparation further comprises at least one of the following miRNA species: hsa-let-7c, hsa-let-7d-5p, hsa-let-7g-5p, hsa-miR-15a-5p, hsa-miR-15b-5p, hsa-miR-16-5p, hsa-miR-17-5p, hsa-miR-18a-5p, hsa-miR-18b-5p, hsa-miR-19a-3p, hsa-miR-19b-3p, hsa-miR-20a-5p, hsa-miR-20b-5p, hsa-miR-23b-3p, hsa-miR-26a-5p, hsa-miR-26b-5p, hsa-miR-29b-3p, hsa-miR-29c-3p, hsa-miR-30b-5p, hsa-miR-30c-5p, hsa-miR-30e-5p, hsa-miR-31-5p, hsa-miR-98-5p, hsa-miR-99b-5p, hsa-miR-103a-3p, hsa-miR-105-5p, hsa-miR-125a-5p, hsa-miR-125b-5p, hsa-miR-126-3p, hsa-miR-128, hsa-miR-130a-3p, hsa-miR-134, hsa-miR-135a-5p, hsa-miR-138-5p, hsa-miR-142-3p, hsa-miR-142-5p, hsa-miR-143-3p, hsa-miR-145-5p, hsa-miR-146a-5p, hsa-miR-148a-3p, hsa-miR-149-5p, hsa-miR-150-5p, hsa-miR-152, hsa-miR-181a-5p, hsa-miR-182-5p, hsa-miR-184, hsa-miR-185-5p, hsa-miR-186-5p, hsa-miR-187-3p, has-miR-191-5p, hsa-miR-194-5p, hsa-miR-195-5p, hsa-miR-196a-5p, hsa-miR-200a-3p, hsa-miR-205-5p, hsa-miR-210, hsa-miR-223-3p, hsa-miR-299-3p, hsa-miR-335-5p, hsa-miR-379-5p, hsa-miR-383, hsa-miR-409-3p, hsa-miR-451a, hsa-miR-493-3p or hsa-miR-574-3p. 